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SUMMARYThis study was carried out to investigate AHR among the group of patients with bronchial asthma and COPD correlating changes-if any- with ventilatory pulmonary function, bronchoalveolar lavage cellularity and inflammatory cells in bronchial biopsy. For this purpose it was carried out at Chest and Histopathological Departments, Faculty of Medicine, Zagazig University Hospital during the period from February 2003 to January 2005.This study primarily included (60) subjects who were classified into 3 groups i.e. as asthmatic, COPD and control groups. Number of patients was (20),(30),and (10) in the three groups respectively.All subjects were subjected to the following:1- Full detailed medical history.2- Full clinical examination.3- Plain chest x-ray.4- Ventilatory pulmonary function tests.5- Arterial blood gasses analysis.6- Complete blood picture (CBC).7-Electrocardiography (ECG).8- Fiberoptic bronchoscopy for:1- bronchoalveolar lavage (BAL).11-bronchial lung biopsy.9-Histopathological examination of the biopsy by hymatoxelen and eosen (H.E.).10-Measurement of BHR using methacholine challenge test.11- Statistical analysis of the previous data was performed.The following results were found:1-There was not a significant correlation between AHR and age / years among studied groups .2-There was a significant increase in intensity of AHR in females than males.3-Cigarette smoking (23.4% mild, 46.6 moderate and 16.6% severe) was the most prominent type of smoking among COPD patients and there was no significant difference between sex among COPD group regarding smoking habit.4-There was a significant negative correlation between AHR and smoking .5- The incidence of complication of MCT as a measure of AHR among studied groups; were cough was (20%), dyspnea was (16.7%), wheeze was (13.4%), and dizzness was (8.4%).This complications were common in asthmatic than COPD groups and in females than males.6-Atopic asthma was more common in young females than non atopic and there was a significant decrease in means of MCT as a measure of AHR in atopic than non atopic groups.7-The most common types of allergen exposure that affect MCT as a measure of AHR were house dust, pollens and the least type of allergen was feather .8- In BAL fluid cellularity and inflammatory cells in bronchial biopsy of asthmatic group, there was a significant increase in percentage of neutrophil, lymphocyte, macrophage of non atopic group while percentage of eosinophil was a significant increase in atopic one .9-The percentage of eosinophils in BAL fluid cellularity was a significantly higher in asthmatic patients comparing with healthy subjects and COPD patients .10-There was a negative correlation between FEV1% changes and the percentage of eosinophils in BAL fluid cellularity of asthmatic patients.11-There was not a significant difference between control and COPD groups regarding BAL fluid cellularity.12-There was not a significant correlation between FEV1% changes and BAL fluid cellularity among COPD patients.13-There was a highly significant increase in inflammatory cells in bronchial biopsy (eosinophil, lymphocyte and macrophage) in asthmatic than control groups.14- Among asthmatic patients, the FEV1 has a highly significant negative correlation with eosinophil number and it has a significant negative correlation with lymphocyte number in bronchial biopsy.15- In COPD group, there was a highly significant increase in lymphocyte and macrophage number in bronchial biopsy than control group while no a significant difference between two groups regarding number of neutrophil and eosinophil.16-There was a significant increase in eosinophil number in bronchial biopsy in asthma than COPD groups while no a significant difference between two groups regarding number of neutrophil, lymphocyte and macrophage in bronchial biopsy.17- Among COPD patients, there was not a significant correlation between eosinophil and neutrophil number in bronchial biopsy and FEV1 and a significant negative correlation between lymphocyte number in bronchial biopsy and FEV1.18- The degree of MCT as a measure of AHR was intense in asthmatic than COPD groups.19- There was a significant negative correlation between duration of illness of (COPD and asthma) and MCT as a measure of AHR.20- The means of MCT as a measure of AHR has a highly significant decrease among (asthmatic and COPD groups) than control group. And it has a highly significant decrease in asthmatic than COPD groups.21- In BAL fluid cellularity of asthmatic group, The MCT as a measure of AHR has a significant negative correlation with eosinophil percentage and it has not a significant correlation between total cell count 106/ ml, and percentage of (neutrophil, lymphocyte, and macrophage) and MCT as a measure of AHR.22-There was a significant negative correlation between MCT as a measure of AHR and peripheral blood eosinophil count among asthmatic group.23- In BAL fluid cellularity among COPD group, there was not a significant correlation between percentage of eosinophil, total cell count, neutrophil, lymphocyte, and macrophage and MCT as a measure of AHR.24- In bronchial biopsy among asthmatic group, the MCT as a measure of AHR has a highly significant negative correlation with number of eosinophil and it has a significant negative correlation with lymphocyte and macrophage numbers while it has not a significant correlation with number of neutrophil.25- In bronchial biopsy of COPD patients, there was not a significant correlation between number of eosinophil, neutrophil, lymphocyte, and macrophage and MCT as a measure of AHR.26- There was a highly significant negative correlation between FEV1% and MCT as a measure of AHR.27- The incidence of squamous metaplesia in the bronchial biopsy of COPD group was(20%).28- The means of MCT as a measure of AHR were a significant decrease in the squamous metaplesia than in no metaplesia groups.29- There was a significant positive correlation between squamous metaplesia and degree of smoking.
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