Eosinophil cationic protein level in bponchial ashma patients with special reference to immunotherapy

The association of bronchial asthma with the release of inflammatory mediators, through a mechanism that involves the immune system is a subject of study every day. The role of eosinophil cationic protein (ECP) in allergic inflammatory reaction has been documented in experimental and clinical studies, but its clinical usefulness is still under discussion. The role of specific immunotherapy in asthma management is under continuous investigation.This study was undertaken to assess the serum and local (BAL fluid) eosinophil cationic protein as an inflammatory mediator involved in asthma pathogenesis and as a prognostic and diagnostic marker of asthma severity and to find any special reference to immunotherapy in asthma management implicating possible impact of immunotherapy on it (ECP).Thirty extrinsic atopic asthmatic patients and ten apparently healthy persons as a control subjects were included in this study.All patients and control subjects were subjected to the following pre treatment measures:1- Thorough medical history stressing on: - Symptoms frequency score.- Medication score.2- Clinical examination compnsmg both general and local chest examination.3- Urine and stool analyses. 4- Skin prick test.5- Plain chest x-ray postero-anterior and lateral views.6- Pulmonary spirometric ventilatory functions in the form of expiratory flow volume curve data were performed before and 20 minutes after inhalation of 4 puff of salbutamol 400 ug via MDI and a spacer.Patients with one or more of the following criteria were excluded from the study:* Subject who had history or x-ray shadow compatable with other concomitant illness.* Patients who cann’t stop inhaled corticosteroid therapy on week before taking the sample.Extrinsic atopic asthmatic patients were classified into 2 groups 15 patients in each one according to line of treatment used:Group I: 15 patients (5 mild asthmatic, 10 moderate asthmatic) received pharmacotherapy only according to Egyptian guideline forGroup 11: 15 patients (5 mild asthmatics, 10 moderate asthmatics), they received pharmacotherapy as group I plus immunotherapy for2- Complete blood picture for estimation eosinophil count in peripheral blood.4- Fiberoptic bronchoscopy and bronchoalveolar lavage for estimation of BAL fluid eosinophil count, ECP level, and urea.• There was very highly significant increase in mean value of absolute eosinophil count in asthmatic patients either estimated in peripheral blood or BAL fluid in comparison with healthy group (P<O.OOl).27.4±4.06 and 47.02±7.68 ng/dl respectively while in control group in serum it was 0.763±0.7 and in BAL 5.7±2.8. There was highly• As regard age, sex and duration of illness, there was a non significant difference in either serum or BAL fluid ECP between male and femaleasthmatic patients. Also there were non significant correlation between ECP either in serum or BAL fluid with age of the patients or duration of illness.• Regarding severity of airflow limitation, there was significant decrease (P<O.OOl) in both serum or BAL fluid ECP in mild asthmatics compared to moderate asthmatic.• There was a significant positive correlation between eosinophil count in peripheral blood and serum ECP (r = 0.84, P<O.OOI).• As regard symptoms and medication scores in all asthmatic patients before and one year after treatment there was a significant reduction in both scores after treatment (P<0.05).• As regard pulmonary function (FEV1% PEFR), it showed a significant improvement after one year of therapy (P<0.05).• On comparing eosinophil count in peripheral blood and in BAL fluid before and one year after treatment there was significant reduction in eosinophil count in both samples after treatment (P<0.05).• Mean value of ECP (ng/dl) level in both serum and BAL before treatment in all asthmatic were 27.4±40.6 and 47.02±7.68 respectively while after therapy its were 24.4±3.5 and 43.47±7.4 respectively with significant decrease in its mean values after treatment.• On comparing group I with group II after one year of therapy as regard symptoms and medication score there was improvement in both scores in group II more than group I inspite of the improvement in medication score was statistically significant (P<0.05) while in symptom score, was not significant.• As regard the effect of treatment upon asthma severity in group I before treatment, the number of patients catagorized to be mild asthmatics was 5 while after treatment this number increased to 7 i.e two moderate cases became mild and non of mild became moderate (P>O.05).• Regarding the effect of combined immunotherapy plus pharmaco¬therapy 4 moderate asthmatics became mild asthmatics after one year of therapy and non of mild asthmatics became moderate asthmatic. This was a statistically significant difference (P<O.05).• A significant decrease in either serum or BAL fluid ECP (ng/dl) in group II when compared with group I after one year of therapy as mean serum ECP in group I was 25.66±3.99 and group II was 23.4±2.1 and BAL fluid mean ECP level were 44.1±7.1 and 41.64±6.6 in group I and group II respectively.