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Correspondence |

Serum Procalcitonin and Infective Exacerbations of AsthmaSerum Procalcitonin and Exacerbations of Asthma FREE TO VIEW

Liesel D’silva, MD; Nesreen Hassan, MBBS; Parameswaran Nair, MD, PhD, FCCP
Author and Funding Information

From the Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, and McMaster University.

Correspondence to: Parameswaran Nair, MD, PhD, FCCP, Firestone Institute for Respiratory Health, St. Joseph’s Hospital, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada; e-mail: parames@mcmaster.ca


Funding/Support: This study was supported by an unrestricted grant-in-aid by GlaxoSmithKline, Canada.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr D’silva is currently employed as a senior medical advisor with GlaxoSmithKline Pharmaceuticals Ltd, India. Dr Nair is listed on a patent for a sputum filtration device that is used to make quantitative cell counts and is supported by a Canada Research Chair in Airway Inflammometry. Dr Hassan has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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;140(5):1389-1390. doi:10.1378/chest.10-2814
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Published online

Bafadhel and colleagues1 report in a recent issue of CHEST (June 2011) that serum procalcitonin levels are high in patients admitted to hospital with pneumonia but not in those admitted with exacerbations of asthma or COPD. We examined the usefulness of serum procalcitonin in patients with moderate to severe exacerbations of asthma due to infections.

We recruited 25 patients (11 men) with confirmed diagnosis of asthma during what was considered an infective exacerbation (increased symptoms as measured by a seven-point Likert scale, increased sputum volume and purulence) that was not severe enough to require hospitalization. None of the patients had radiologic evidence of pneumonia. Spirometry was performed and nasopharyngeal swabs and sputum were obtained for virology,2 bacterial culture, and quantitative cell counts.3 Measurements were repeated at 1, 4, and 6 weeks until symptoms had completely resolved. Procalcitonin was measured in serum at the time of exacerbation and at 6 weeks. Procalcitonin was measured in duplicate from 50 μL of serum using a time-resolved amplified cryptate emission technology assay (Kryptor TRACE PCT; Brahms; Berlin, Germany). The lower limit of detection is 0.02 ng/mL, and the assay functional sensitivity was 0.06 ng/mL. All patients gave written informed consent, and the study was approved by the Research Ethics Board of St. Joseph’s Healthcare Hamilton.

Test results in 15 subjects (60%) had positive identification of a pathogen; five (20%) were viral (one influenza B, one respiratory syncytial virus, one human metapneumovirus, and one parainfluenza 4 and rhinovirus, human coronavirus NL63), two (8%) were bacterial (Streptococcus pneumoniae and Haemophilus parainfluenzae), and four (16%) were both bacterial and viral (Moraxella and rhinovirus, Streptococcus pneumoniae and human coronavirus NL63, Streptococcus pneumonia and influenza B, and Staphylococcus aureus and parainfluenza 3).

Symptoms and FEV1 improved significantly, and the sputum cell counts returned to normal at 6 weeks (Table 1). However, there was no significant difference in procalcitonin levels between the initial measurement and at 6 weeks (Table 1). There were also no differences between patients who had infective vs noninfective exacerbations or those with viral vs bacterial bronchitis.

Table Graphic Jump Location
Table 1 Measurements During an Exacerbation and 6 Weeks Later

Values are given as mean (SD) unless otherwise noted. E = eosinophil; N = neutrophil; TCC = total cell count.

a 

Symptoms of cough, chest tightness, wheeze, and shortness of breath were measured on a seven-point Likert score (7 best, 1 worst).

b 

Median (interquartile range).

c 

Median (minimum-maximum).

Our data confirm the observations of Bafadhel and colleagues1 that serum procalcitonin is unlikely to be useful to identify infective exacerbations of asthma. Elevated sputum total cell count with predominant neutrophilia is a more reliable indicator of an infective bronchitis.

Role of sponsors: Procalcitonin measurements were made by Brahms GmbH, Berlin, Germany. None of the sponsors was involved in the development of the protocol, acquisition and interpretation of data, statistical analysis or preparation of the manuscript.

Other contributions: The procalcitonin measurements were facilitated by Rudolf Nothelfer, PhD, BRAHMS Aktiengesellschaft, and virology by Jim Mahony, PhD, McMaster University.

Bafadhel M, Clark TW, Reid C, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or chronic obstructive pulmonary disease. Chest. 2011;1396:1410-1418 [CrossRef] [PubMed]
 
Mahony J, Chong S, Merante F, et al. Development of a respiratory virus panel test for detection of twenty human respiratory viruses by use of multiplex PCR and a fluid microbead-based assay. J Clin Microbiol. 2007;459:2965-2970 [CrossRef] [PubMed]
 
Nair P, Hargreave FE. Measuring bronchitis in airway diseases: clinical implementation and application: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010;138suppl 2:38S-43S [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 Measurements During an Exacerbation and 6 Weeks Later

Values are given as mean (SD) unless otherwise noted. E = eosinophil; N = neutrophil; TCC = total cell count.

a 

Symptoms of cough, chest tightness, wheeze, and shortness of breath were measured on a seven-point Likert score (7 best, 1 worst).

b 

Median (interquartile range).

c 

Median (minimum-maximum).

References

Bafadhel M, Clark TW, Reid C, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or chronic obstructive pulmonary disease. Chest. 2011;1396:1410-1418 [CrossRef] [PubMed]
 
Mahony J, Chong S, Merante F, et al. Development of a respiratory virus panel test for detection of twenty human respiratory viruses by use of multiplex PCR and a fluid microbead-based assay. J Clin Microbiol. 2007;459:2965-2970 [CrossRef] [PubMed]
 
Nair P, Hargreave FE. Measuring bronchitis in airway diseases: clinical implementation and application: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010;138suppl 2:38S-43S [CrossRef] [PubMed]
 
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