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Editorials: POINT/COUNTERPOINT EDITORIALS |

Point: Is Measuring Sputum Eosinophils Useful in the Management of Severe Asthma? Yes

Frederick E. Hargreave, MBChB, MD; Parameswaran Nair, MD, PhD
Author and Funding Information

From the Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton; and the Department of Medicine, McMaster University.

Correspondence to: Frederick E. Hargreave, MBChB, MD, Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada; e-mail: hargreav@mcmaster.ca


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Drs Hargreave and Nair have a patent on a filter device provided in a kit to process and examine sputum for quantitative inflammatory cell counts and fluid phase indices. This has not been marketed, and there is currently no profit from this. Drs Hargreave and Nair’s university hospital laboratory acts as a central laboratory to teach, control quality, troubleshoot, and examine sputum in multicenter drug trials. Drs Hargreave and Nair provide teaching videos for sputum induction and examination through e-learning at machealth.ca.

Funding/Support: Dr Nair is supported by a Canada Research Chair in Airway Inflammometry.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1270-1272. doi:10.1378/chest.11-0618
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Published online

Extract

It should be a nonissue to agree that measuring sputum eosinophils is useful in the management of severe asthma. We would add that the clinical value is enhanced by additional measurements of total nonsquamous cell count (expressed as 1 million per gram of sputum selected from saliva), neutrophils, and other cellular indices.

Asthma is recognized as a chronic disease of the airways of the lungs, presenting with symptoms that are characterized by variable airflow limitation, airway hyperresponsiveness, and airway inflammation.1 Because there is no unifying cause, its recognition depends on the presence of the physiologic abnormalities; symptoms are nonspecific and sometimes insensitive and airway inflammation is not always present.2,3 However, the severity of asthma is graded primarily by the inflammatory component of the disease, the minimum daily dose of corticosteroid required to maintain control, or the best results once factors that aggravate asthma have been excluded.4 The designation of severe asthma is now reserved for patients with severe refractory asthma, which is only controlled (or still uncontrolled) by high-intensity treatment of ≥1,000 μg fluticasone equivalent or added ingested corticosteroid (in addition to long-acting β agonist or any other controller medications, if they are beneficial), which confer a risk of serious adverse effects of treatment.5,6 Severe refractory asthma needs to be distinguished from difficult asthma, which remains uncontrolled, despite high-intensity treatment, because of persisting aggravating factors that if removed might reduce the severity. Patients with severe refractory or difficult asthma should be assessed by a specialist and receive personalized treatment of the components and the causes or aggravating factors.

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