Inflammatory cells and eosinophilic activity in asthmatics investigated by bronchoalveolar lavage. The effects of antiasthmatic treatment with budesonide or terbutaline

Abstract

We investigated the constituents of bronchoalveolar lavage (BAL) regarding cell profiles and released eosinophilic cationic protein (ECP) in 11 patients treated occasionally with inhaled bronchodilators (Group A) and 11 patients treated regularly with inhaled corticosteroids (Group B). A normal, healthy control group of 12 subjects was also recruited. Compared with Group A, Group B had a reduced recovery percentage of infused volume (p<0.05) and total cell number (p<0.01). Compared with the control group, there was a significant increase in the percentage of eosinophils (p<0.05) in both groups of asthmatics. In Group A there was also a significant increase in mast cells (p<0.05), serum-ECP (p<0.05), and BAL-ECP (p<0.001). No correlations between any of the cell variables and the level of airway responsiveness measured as PC20 histamine were found in any group. Group A patients were investigated twice- before and after 4 wk of randomly allocated treatment with either a regular beta-2-receptor agonist (terbutaline 250 μg, two puffs four times a day) or a regularly inhaled corticosteroid (budesonide 200 μg twice a day). The BAL differential cell counts were similar and not significantly affected by either treatment. However, BAL-ECP levels were decreased by budesonide treatment (p<0.05). ECP levels in serum and BAL were significantly correlated (p<0.05 to 0.001). The eosinophilic cell involvement in asthma is further emphasized by this study but the increase in numbers of eosinophils seems less important than their activity, here measured as release of one degranulation products, ECP. To suppress disease activity, repeated long-term treatment is important, but clear preference for either treatment cannot be given on the basis of our present results.