Published ahead of print on August 4, 2005, doi:10.1164/rccm.200504-619OC
Am. J. Respir. Crit. Care Med., Volume 172, Number 7, October 2005, 837-841
A more recent version of this article appeared on October 1, 2005
Submitted on April 20, 2005
Accepted on August 2, 2005
Bronchial CD8 Cell Infiltrate and Lung Function Decline in Asthma
Elizabeth L.J. van Rensen1, Jacob K Sont2, Christine E Evertse1, Luuk N.A. Willems1, Thais Mauad3, Pieter S Hiemstra1, Peter J Sterk1*, and the AMPUL study group1
1 Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands,
2 Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands,
3 Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil
* To whom correspondence should be addressed. E-mail: p.j.sterk{at}lumc.nl.
Rationale Patients with asthma have an accelerated decline in lung function, which can lead to irreversible airway obstruction. It is generally assumed that this is related to specific aspects of airway inflammation and/or remodelling.
Objective We investigated the prognostic significance of bronchial eosinophil and CD8+ cell counts and subepithelial reticular layer thickness for the subsequent decline in lung function in patients with asthma after 7.5 years of follow-up.
Methods In a prospective study, pre- and post-bronchodilator lung function (FEV1) was measured at baseline, after 2 years and 7.5 years in 32 patients with asthma. Annual decline in lung function after 7.5 years of follow-up was related to type and severity of airway inflammation and remodelling in bronchial biopsies, which were taken at baseline and at year 2.
Results Annual decline in post-bronchodilator FEV1 (mean (SD) 46.6 (53.4) ml/yr) was significantly larger than the decline in pre-bronchodilator FEV1 (mean (SD) 27.5 (62.5) ml/yr), indicating loss in reversibility. Whereas, annual fall in post-bronchodilator FEV1 was not related to thickness of the reticular layer or to eosinophil counts in bronchial biopsies, there was a significant correlation with CD8 positive T-cells (r=-0.39;p=0.032). Analyzing the biopsies taken at year 2, the significant association between annual fall in post-bronchodilator FEV1 and CD8 cells could independently be confirmed(r=-0.39;p=0.036).
Conclusion The outcome of asthma, as determined by the annual decline in FEV1, can be predicted by the bronchial CD8+ cell infiltrate. This suggests that the inflammatory phenotype in asthma has prognostic relevance, which may require phenotype-specific therapeutic strategies.
Key words: asthma, CD8 cells, lung function decline, prognosis, inflammation
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