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Am. J. Respir. Crit. Care Med., Volume 158, Number 5, November 1998, 1511-1517

Sputum Eosinophilia Predicts Benefit from Prednisone in Smokers with Chronic Obstructive Bronchitis

EMILIO PIZZICHINI, MARCIA M. M. PIZZICHINI, PETER GIBSON, K. PARAMESWARAN, GERALD J. GLEICH, LES BERMAN, JERRY DOLOVICH, and FREDERICK E. HARGREAVE

Departments of Medicine and Paediatrics, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada; Department of Respiratory Medicine, John Hunter Hospital, Newcastle, Australia; and Departments of Immunology and Medicine, Mayo Clinic and Foundation, Rochester, Minnesota

A reliable predictor of benefit from corticosteroid treatment in patients with chronic airflow limitation is needed. In a single-blind, sequential crossover trial of placebo and prednisone (30 mg/day) treatment, with each given for 2 wk, we investigated whether an increased proportion of sputum eosinophils (>=  3%) predicts a beneficial effect of prednisone in smokers with severe obstructive bronchitis. Patients were seen before and after each treatment. Clinical measurements were made blind to the laboratory findings and vice-versa. Eighteen of 20 patients completed the study. Eight had sputum eosinophilia and similar clinical and physiologic characteristics to those of 10 patients without a finding of sputum eosinophilia. Only in patients with sputum eosinophilia did prednisone, as compared with placebo, produce a statistically significant and clinically important mean effect on effort dyspnea of 0.8 (95% confidence interval [CI]: 0.3 to 1.2), p = 0.008, and in quality of life of 1.96 (95% CI: 0.5 to 3.3), p = 0.01, associated with a small improvement in FEV1 of 0.11 L (95% CI: - 0.04 to 0.23 L), p = 0.05. In these patients, prednisone also produced a significant decline in the median sputum eosinophil percentage, from 9.7% to 0.5% (p = 0.002), eosinophil cationic protein (ECP), from 6,000 µg/L to 1,140 µg/L (p < 0.001), and fibrinogen, from 25.3 mg/L to 5.4 mg/L (p < 0.001). These findings indicate that in smokers with severe airflow limitation, sputum eosinophilia predicts a beneficial effect of prednisone treatment. Improvement in FEV1, after prednisone treatment in this population, is small, and may not be appreciated in clinical practice.




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