IP Indian Journal of Immunology and Respiratory Medicine


A study on sputum cytological phenotypes among bronchial asthma patients during exacerbations in a tertiary care center


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Article Type : Research Article

Author Details: Gayathri Ganapathy*,Sathish Kumar Mani,Sudha Vasudeven,Anbumaran Parivakkam Mani,Gangadharan Vadivelu

Volume : 4

Issue : 3

Online ISSN : 2581-4222

Print ISSN : 2581-4214

Article First Page : 185

Article End Page : 189


Abstract

Background: Asthma is a chronic reversible airway disease which is emerging as an important public health problem in era of raising air pollution. There is diversified population of patients from children, adults to advanced ages who are victims of bronchial asthma. It has been a regular practice in modern day medicine to perform a spirometry to assess the severity of asthma. In the recent times, more interest has been drawn towards the sputum phenotypes in better understanding of pathogenesis of asthma. Our study aims at looking into spirometric evaluation in correlation with sputum cytological phenotypes. 
Methodology: Patients attending the chest clinic with clinical features of exacerbation of bronchial asthma above 18 years of age are taken into the study. Chest X-ray is taken rule out pneumonia, tuberculosis and pulmonary infiltrate with eosinophilia syndrome. They are subjected to perform spirometry with post bronchodilator response to confirm the diagnosis of asthma and severity of asthma classified as per GINA guidelines. Sputum samples of these patients are taken to determine their phenotypes.
Results: A total of 135 patients participated in the study. Out of which 22 patients were not taken into the study considering inability to perform a spirometry and some of them were excluded as they submitted salivary sample as they were found to be salivary samples and some of them could not perform a satisfactory spirometry test. A total of 113 of sputum samples were accepted for cytological examination. Among these patients, 49% were male patients and 50% were female patients. The common cellular phenotypes identified was Eosinophlic with 44.2%, neutrophilic occupying43.4% and lymphocytic with 2.7% and no specific cell types in some samples (9.7%). Among the severe persistent type of asthma, most of patients had neutrophils in their sputum cytology (59%). Milder forms of asthma patients mostly recovered with eosinophil in their sputum cytology reports (40%).
Conclusions: Even though asthma was thought to be a disease which invites eosinophil in the airway, there is a switch over to neutrophilic type of asthma in severe forms of asthma. Sputum cytology among patients with asthma exacerbations may a add on and guiding tool in addition to spirometry in the management of asthma exacerbations.

Keywords: Eosinophilic; Neutrophilic; Sputum cytological phenotypes; Severe persistent asthma.

Doi :-https://doi.org/10.18231/j.ijirm.2019.041