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Pharmacotherapy

Characteristics of eosinophilic and non-eosinophilic asthma during treatment with inhaled corticosteroids

Toshiki FurukawaDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD,

Takuro SakagamiDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and Correspondence[email protected]

, MD, PhD,

Toshiyuki KoyaDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD, PhD,

Takashi HasegawaDepartment of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan

, MD, PhD,

Hidenori KawakamiDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD, PhD,

Yosuke KimuraDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD,

Yoshifumi HoshinoDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD,

Hirotaka SakamotoDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD,

Kenjiro ShimaDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD,

Keisuke TsukiokaDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD,

Mio ToyamaDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD,

Masachika HayashiDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD, PhD,

Hiroshi KagamuDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD, PhD,

Ei-ichi SuzukiDepartment of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan

, MD, PhD &

Ichiei NaritaDivision of Respiratory Medicine, Department of Homeostatic Regulation and Development, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, and

, MD, PhD show all

Abstract

Objective: Eosinophilic inflammation in the respiratory tract is a hallmark of bronchial asthma. In naïve cases, the inflammatory profile is associated with disease severity and reactivity to inhaled corticosteroids (ICS). Sustained airway eosinophilia has been reported during ICS treatment. However, the immunological characteristics of these cases are not known and it is unclear if this situation contributes to asthma control. This study was performed to determine the answer of these questions. Methods: To compare phenotypes of eosinophilic and non-eosinophilic asthma (EA and NEA, respectively) under ICS treatment, clinical data were obtained from asthmatic subjects (n = 22) and healthy controls (n = 10), and the leukocyte compositions of induced sputum and peripheral blood were determined. T lymphocyte profiles in systemic blood were assessed by flow cytometry. Results: A higher frequency of emergency room visits was observed in the NEA group, which had a higher neutrophil count relative to the total inflammatory cell population in induced sputum than the EA group (59.5 versus 36.6%; p < 0.01). The fraction of helper T (Th)17 lymphocytes as well as the ratio of Th17 to regulatory T cells (Treg) in the peripheral blood was higher in the NEA than in the EA group (0.24 versus 0.13; p < 0.05). Conclusions: Th17 were more prevalent than Treg cells in the peripheral blood of NEA patients under ICS treatment, corresponding to neutrophil-dominant airway inflammation and a severe asthmatic phenotype. Thus, an imbalance in Th17/Treg may be associated with the pathogenesis of NEA in patients undergoing ICS treatment.

Keywords

Acknowledgements

The authors thank Asako Takiguchi for expert help in the physiological examinations.

Declaration of interest

The authors declare that they have no competing interests.

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Characteristics of eosinophilic and non-eosinophilic asthma during treatment with inhaled corticosteroids

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Characteristics of eosinophilic and non-eosinophilic asthma during treatment with inhaled corticosteroids

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