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Key cases – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Comment 2: Compelling evidence of type-2 airway inflammation in the absence of airflow limitation and airway hyperresponsiveness consistent with a diagnosis of eosinophilic bronchitis. This is a strong basis for a treatment trial with an inhaled corticosteroid. This treatment opportunity would have been missed if initiation of treatment had relied on the demonstration of asthma.
Pulmonary Eosinophilia
Published in Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley, Diagnostic Pulmonary Pathology, 2008
Eosinophilic bronchitis is another recently described entity consisting of patients who have a pattern of airway eosinophilia and inflammation typical of asthma yet whose only symptom is chronic cough. Unlike patients with asthma, wheezing, or dyspnea is not prominent and tests of airway responsiveness are normal. Morphologic studies are few, but patients identified with eosinophilic bronchitis show pathologic features on endobronchial biopsy otherwise typical of asthma including submucosal and intraepithelial eosinophilia and commensurate thickening of the basement membrane. A similar pattern of eosinophilia is likewise present on assessment of BAL and induced sputa (126–132). As noted above, in comparison to patients with asthma, patients with eosinophilic bronchitis as well as normal control lack mast cells within bronchial smooth muscle—a finding that suggests a role for the intramuscular localization of mast cells in the airway hyperreactivity and bronchoconstriction of asthma (111).
Improving the risk-to-benefit ratio of inhaled corticosteroids through delivery and dose: current progress and future directions
Published in Expert Opinion on Drug Safety, 2022
Piotr Damiański, Grzegorz Kardas, Michał Panek, Piotr Kuna, Maciej Kupczyk
Inhaled corticosteroids currently are, and in the near future will remain, the mainstream therapy for several acute and chronic airway diseases, including but not limited to asthma, COPD and eosinophilic bronchitis. The above statement remains true despite huge investments and tremendous clinical efficacy of new molecules and biologics, especially directed against key mechanisms involved in the T2 predominant inflammation. In general, ICS are the most effective in regard to clinical outcomes and pharmacoeconomic aspects anti-inflammatory topical agents in airway diseases characterized by ongoing inflammation. Taking asthma as an example, when ICS were introduced into management, large improvements were seen in symptom control, lung function, exacerbations rate and asthma-related mortality rate. ICS are effective in the majority of patients despite well-known heterogeneity both in regard to phenotypes and endotypes of asthma.
Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis
Published in Annals of Medicine, 2021
Pasquale Ambrosino, Mariasofia Accardo, Marco Mosella, Antimo Papa, Salvatore Fuschillo, Giorgio Alfredo Spedicato, Andrea Motta, Mauro Maniscalco
Among the peripheral stimuli for cough reflex, eosinophilic airway inflammation is one of the most frequent and, consequently, one of the most studied in terms of pathophysiology and clinical implications [7]. Having this airway inflammation a good response to inhaled corticosteroids (ICS) [8], it is crucial to identify potential ICS responders to enable tailored therapeutic strategies and avoid treatment failures or adverse drug reactions [2]. Conventionally, induced sputum eosinophil count has been used to diagnose eosinophilic airway inflammation, thus driving decisions on ICS treatment in patients with asthma, eosinophilic bronchitis and atopic cough [9]. However, this method is technically and logistically challenging, being currently restricted to a limited number of specialised centres.
Optimizing sputum cell counts prior to bronchial thermoplasty: A preliminary report
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2019
Sarah Svenningsen, Hui Fang Lim, Sarah Goodwin, Melanie Kjarsgaard, Grace Parraga, John Miller, Gerard Cox, Parameswaran Nair
For patients in the inflammation-optimized group, quantitative cytometry of induced sputum was first performed 132 [68–935] days prior to BT to characterize the nature of bronchitis. Eosinophilic bronchitis was identified in 2 patients (P8 and P14) and recurrent neutrophilic bronchitis was identified in 1 patient (P12); and in the remaining 4 patients, no clinically relevant bronchitis was identified indicating that the current medication was adequate. For patients P8 and P14, the dose of corticosteroids was increased to normalize sputum eosinophils (<3%). For patient P12, 6 weeks of antibiotics guided by molecular microbiology and extended cultures, hypertonic saline nebulization and monthly intravenous immunoglobulin therapy were initiated to normalize sputum neutrophils (<64%).13 The inflammation-optimization period was 862 days for P8, 33 days for P14, and 567 days for P12. Sputum cell counts were normalized for all patients in the optimized group 83 [42–193] days prior to proceeding with BT.