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Published ahead of print on November 8, 2002, doi:10.1164/rccm.200203-183OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 3, February 2003, 418-424

A more recent version of this article appeared on February 1, 2003
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Submitted on March 11, 2002
Accepted on October 24, 2002

DIFFERENCES IN AIRWAY INFLAMMATION IN PATIENTS WITH FIXED AIRFLOW OBSTRUCTION DUE TO ASTHMA OR COPD

Leonardo M Fabbri1*, Micaela Romagnoli1, Lorenzo Corbetta2, Gianluca Casoni1, Kamelija Busljetic3, Graziella Turato4, Guido Ligabue5, Adalberto Ciaccia6, Marina Saetta7, and Alberto Papi6

1 Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy; Department of Respiratory Diseases, University or Modena & Reggio Emilia, Modena, Italy, 2 Department of Respiratory Diseases, University or Modena & Reggio Emilia, Modena, Italy, 3 Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy; Department of Respiratory Medicine, University of Skopje, Skopje, Macedonia (Yugoslav Republic), 4 Department of Respiratory Diseases, University or Modena & Reggio Emilia, Modena, Italy; Department of Clinical and Experimental Medicine, Section of Respiratory Diseases, University of Padova, Padova, Italy, 5 Department of Radiology, University of Modena & Reggio at Emilia, Modena, Italy, 6 Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy, 7 Department of Clinical and Experimental Medicine, Section of Respiratory Diseases, University of Padova, Padova, Italy

* To whom correspondence should be addressed. E-mail: fabbri.leonardo{at}unimo.it.

To determine whether patients with fixed airflow obstruction have distinct pathological and functional characteristics depending on a history of either asthma or COPD, we characterized 46 consecutive outpatients presenting with fixed airflow obstruction by clinical history, pulmonary function tests, exhaled NO, sputum analysis, bronchoalveolar lavage, bronchial biopsy, and high-resolution computed tomography (HRCT) chest scans. Subjects with a history of COPD (n=27) and subjects with a history of asthma (n=19) had a similar degree of fixed airflow obstruction (FEV1: 56 ± 3 vs. 56 ± 2% predicted) and airway hyperresponsiveness (PC20FEV1: 2.81 [3.1] vs. 1.17 [3.3]). Subjects with a history of asthma had significantly more eosinophils in peripheral blood, sputum, bronchoalveolar lavage, and airway mucosa; fewer neutrophils in sputum and bronchoalveolar lavage fluid; a higher CD4+/CD8+ ratio of T cells infiltrating the airway mucosa; and a thicker reticular layer of the epithelial basement membrane. They also had significantly lower residual volume, higher diffusing capacity, higher exhaled NO, lower HRCT scan emphysema score, and greater reversibility to bronchodilator and steroids. In conclusion, despite similar fixed airflow obstruction, subjects with a history of asthma have distinct characteristics compared with subjects with a history of COPD and should be properly identified and treated.
Key words: smoking, airway, inflammation, bronchitis, emphysema




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