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a Department of
Pulmonology, University Hospital, 9700 RB Groningen, The Netherlands, b Department of Allergology, c Department of Pathology
Correspondence to: Dr D S Postma
Received 30 April 1999; Returned to authors 12 July 1999; Revised version received 27 August 1999; Accepted for publication 8 September 1999
BACKGROUND
Inflammatory
changes in the airways in chronic obstructive pulmonary disease (COPD)
are largely attributed to smoking, yet they may be present even if
patients do not currently smoke. The differences in inflammatory cells
and the factors contributing to these differences were examined in the
airways of patients with COPD who do not currently smoke.
METHODSEighteen
non-atopic subjects with COPD (14 men) of mean (SD) age 62 (8) years
and forced expiratory volume in one second (FEV1) 59 (13)%
predicted and 11 non-atopic healthy subjects (eight men) of mean (SD)
age 58 (8) years, FEV1 104 (11)% predicted were studied. Sputum induction and bronchoscopy with bronchoalveolar lavage (BAL) and
biopsies were performed.
RESULTSPatients with
COPD had more mucosal EG2+ cells (eosinophils) (median (range) 40 (0-190) versus 5 (0-40) cells/mm2, p = 0.049) and CD68+
cells (1115 (330-2920) versus 590 (450-1580) cells/mm2, p = 0.03), and a tendency towards more CD4+ but not CD8+ lymphocytes than
healthy controls. Furthermore, patients with COPD had higher percentages of sputum neutrophils (77 (29-94) versus 36 (18-60)%, p = 0.001) and eosinophils (1.2 (0-8.5) versus 0.2 (0-3.1)%, p = 0.008), BAL fluid eosinophils (0.4 (0-1.7) versus 0.2 (0-0.5)%, p = 0.03), and higher concentrations of sputum eosinophilic cationic protein (ECP) (838 (115-23 760) versus 121 (35-218) ng/ml,
p<0.001). Concentrations of ECP expressed per eosinophil were not
higher. Patients with COPD with high mucosal EG2+ cell numbers also had high mucosal CD4+ cell numbers. Sputum eosinophilia was associated with
a decrease in FEV1/VC and BAL fluid eosinophilia with a
decrease in mucosal NP57+ cells (neutrophils).
CONCLUSIONSSubjects
with COPD who do not currently smoke have increased numbers of
inflammatory cells. Eosinophils are increased in number in the
airways in COPD but do not seem to be activated. The increased eosinophil numbers are probably due to recruitment as a result of
ongoing inflammation. Macrophages and lymphocytes may play a part in
this inflammation.
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