Non invsive methods of infammation in brochiectasis

Introduction: Bronchiectasis is a heterogeneous entity, taking into account clinical characteristics, inflammatoryresponse, effectiveness of treatment and frequency of exacerbations. In stable state non-cystic fibrosis (non-CF)bronchiectasis, little is known about non-invasive techniques used for evaluating airway inflammation in obstructiveairway diseases.Objectives: We sought to evaluate the associations between induced sputum and clinical/radiologic characteristics,and the differences between biomarkers expressing Th1 and Th2 response in patients with non-CFbronchiectasis and to compare our findings with a previously studied population of patients with asthma andCOPD.Methods: We evaluated prospectively collected data from subjects with bronchiectasis. Comparisons were madebetween clinical, radiographic and physiologic characteristics, as well as induced sputum markers using appropriatestatistical tools. We compared the levels of sputum markers with those of a previously studied cohort ofasthma and COPD patients.Results: We enrolled 40 subjects (21 men, mean age 63.5 yrs) with bronchiectasis. Fifteen subjects (37.5%) had aneutrophilic phenotype, 7 (17.5%) had an eosinophilic phenotype, 3 (12.5%) had a mixed neutrophilic-eosinophilicphenotype and 15 (37.5%) had a paucigranulocytic phenotype. Subjects with sputum neutrophilia hadmore severe bronchiectasis in HRCT and higher levels of IL-8 in sputum, whereas subjects with eosinophilia hadhigher levels of FeNO, greater bronchodilator reversibility and higher sputum IL-13. Sputum IL-8 levels werehigher in subjects exhibiting frequent exacerbations and correlated with neutrophils in sputum (r =0.799), theextent of bronchiectasis in HRCT (r =0.765) and post-bronchodilator FEV1 (r =−0.416). Sputum IL-13 levelscorrelated with sputum eosinophils (r= 0.656) and bronchodilator reversibility (r= 0.441). Neutrophilicbronchiectasis exhibited comparable IL-8 levels to COPD, whereas eosinophilic bronchiectasis showed significantlylower IL-13 levels compared to asthma.Conclusions: Sputum cell counts and IL-8 and IL-13 correlate with distinct clinical and functional measurementsof disease severity and therefore may have a role for non-invasively assessing inflammation in non-cystic fibrosisbronchiectasisΗ μη επεμβατική αξιολόγηση της φλεγμονής των αεραγωγών μπορεί να δώσει σημαντικές πληροφορίες για την θεραπευτική αντιμετώπιση ασθενών με νοσήματα του αναπνευστικού. Μέσω της μέτρησης φλεγμονωδών κυττάρων και μεσολαβητών στο υπερκείμενο των προκλητών πτυέλων (κυτταροκίνες, πρωτεΐνες, ηωσινοφιλικές πρωτεΐνες) δύναται να εκτιμηθεί ο βαθμός φλεγμονής και αναδιαμόρφωσης των αεραγωγών. Η ευρεία εφαρμογή της πρόκλησης πτυέλων στο άσθμα και ΧΑΠ έχει δώσει πληροφορίες για τη σχέση πνευμονικής λειτουργίας και φλεγμονής των αεραγωγών, ενώ παράλληλα έχει προτείνει νέους φαινότυπους με διαφορετική απάντηση στη θεραπεία. Παρόλα αυτά, λίγα δεδομένα υπάρχουν για τη χρησιμότητά της μη επεμβατικής αξιολόγησης της φλεγμονής σε ασθενείς με βρογχεκτασίες υπό σταθερές συνθήκες