Update on Clinical Inflammometry for the Management of Airway Diseases

Canadian Respiratory Journal, Sep 2018

Airway inflammation is a central feature of many airway diseases such as asthma, chronic bronchitis, bronchiectasis and chronic cough; therefore, it is only logical that it is measured to optimize its treatment. However, most treatment recommendations, including the use of anti-inflammatory therapies such as corticosteroids, are based on assessments of only airflow and symptoms. Over the past 10 years, methods have been developed to assess airway inflammation relatively noninvasively. Quantitative cell counts in sputum and the fraction of exhaled nitric oxide are the most validated tests. Judicious use of currently available drugs, such as corticosteroids, bronchodilators and antibiotics, and other anti-inflammatory therapies guided by sputum eosinophil and neutrophil counts, have been demonstrated to decrease exacerbations of asthma and chronic obstructive pulmonary disease, ameliorate cough, improve quality of life in patients with these diseases and is cost effective compared with treatment strategies based on guidelines that do not incorporate these measurements. Thus, it is unfortunate that this is not used more widely in the management of airway diseases, particularly in patients with severe asthma and chronic obstructive pulmonary disease who experience frequent exacerbations.

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Update on Clinical Inflammometry for the Management of Airway Diseases

Can Respir J Update on clinical inflammometry for the management of airway diseases Parameswaran Nair FRCPC 0 0 Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton and the Department of Medicine, McMaster University , Hamilton, Ontario Hamilton, Ontario L8N 4A6. Telephone 905-522-1155 ext 35044, fax 905-521-6183, e-mail P nair. Update on clinical inflammometry for the management of airway diseases. Can respir J 2013;20(2):117-120. Airway inflammation is a central feature of many airway diseases such as asthma, chronic bronchitis, bronchiectasis and chronic cough; therefore, it is only logical that it is measured to optimize its treatment. However, most treatment recommendations, including the use of anti-inflammatory therapies such as corticosteroids, are based on assessments of only airflow and symptoms. Over the past 10 years, methods have been developed to assess airway inflammation relatively noninvasively. Quantitative cell counts in sputum and the fraction of exhaled nitric oxide are the most validated tests. Judicious use of currently available drugs, such as corticosteroids, bronchodilators and antibiotics, and other anti-inflammatory therapies guided by sputum eosinophil and neutrophil counts, have been demonstrated to decrease exacerbations of asthma and chronic obstructive pulmonary disease, ameliorate cough, improve quality of life in patients with these diseases and is cost effective compared with treatment strategies based on guidelines that do not incorporate these measurements. Thus, it is unfortunate that this is not used more widely in the management of airway diseases, particularly in patients with severe asthma and chronic obstructive pulmonary disease who experience frequent exacerbations. Asthma; COPD; Cough; Exhaled nitric oxide; Inflammometry; Sputum - Apersistence of asthma ( 1 ) and other airway diseases such as irway mucosal inflammation is fundamental to the etiology and smoker’s bronchitis, emphysema, chronic cough and bronchiectasis. It contributes to symptoms, variable airflow limitation and airway hyperresponsiveness and the structural changes (ie, remodelling) associated with asthma. The presence and type of airway inflammation can be difficult to detect clinically, delaying the introduction of appropriate treatment ( 2 ). However, until recently, its measurement was not considered by national and international guidelines that recommended treatment based only on symptoms and measurement of airflow. The Canadian Thoracic Society pioneered the introduction of these measurements in the management of chronic obstructive pulmonary disease (COPD) ( 3 ) and asthma ( 4 ) in the most recent iteration of their guidelines. The present review will summarize the methods that are currently under evaluation for the measurement of airway inflammation in clinical practice and discuss the practical implementation of quantitative sputum cell counts in the management of asthma, COPD and chronic cough as practiced at the Firestone Institute of Respiratory Health at St Joseph’s Healthcare in Hamilton, Ontario, for the past 20 years. The present update does not review indirect measures of airway inflammation such as mannitol (Aridol, Pharmaxis, Australia) hyper-responsiveness. Methods to assess airway inflaMMation sputum Sputum cell counts are a relatively noninvasive and reliable method of identifying airway inflammation. The method of sputum collection is well described and standardized ( 5 ). Hypertonic saline inhalation is safe in patients with forced expiratory volume in 1 s (FEV1) as low as 0.9 L ( 6 ). Spontaneously expectorated sputum, when available, provides Mise à jour sur l’inflammométrie clinique pour prendre en charge les maladies des voies respiratoires L’inflammation des voies respiratoires est un élément central de nombreuses maladies des voies respiratoires comme l’asthme, la bronchite chronique, la bronchiectasie et la toux chronique. Par conséquent, il est logique de la mesurer pour en optimiser le traitement. Cependant, la plupart des recommandations thérapeutiques, y compris le recours à des traitements anti-inflammatoires comme les corticoïdes, se fondent sur des évaluations limitées au débit respiratoire et aux symptômes. Depuis dix ans, des méthodes ont été mises au point pour évaluer l’inflammation des voies respiratoires de manière relativement non envahissante. Le dénombrement cellulaire quantitatif dans les expectorations et la fraction de monoxyde d’azote exhalé sont les tests les plus validés. Il est démontré qu’une utilisation judicieuse des médicaments sur le marché, tels que les corticoïdes, les bronchodilatateurs et les antibiotiques, et d’autres traitements antiinflammatoires sélectionnés selon la numération des éosinophiles et des neutrophiles dans les expectorations, réduit les exacerbations d’asthme et de maladie pulmonaire obstructive chronique, limite la toux, améliore la qualité de vie chez les patients atteint (...truncated)


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Parameswaran Nair. Update on Clinical Inflammometry for the Management of Airway Diseases, Canadian Respiratory Journal, 20, DOI: 10.1155/2013/602936