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ORIGINAL ARTICLE Sputum Infammatory Cells and their Impact on Asthma Control in Adults: A Prospective Study Anil Kumar Jain 1 , Prabhpreet Sethi 2 , Bharat Janpathi 3 , Shalini Mullick 4 Received on: 24 January 2022; Accepted on: 02 June 2022; Published on: 05 December 2022 A BSTRACT Background: Asthma is broadly categorized as eosinophilic or noneosinophilic. Noneosinophilic asthma (NEA) can be paucigranulocytic asthma (PGA), mixed granulocytic asthma (MGA), or neutrophilic asthma (NeuA). A relationship between the cytological type of infammation and response to treatment with inhaled corticosteroids (ICS) in asthma has been of great interest. The objective of the current study was to predict the control of asthma according to sputum infammatory cells. Materials and methods: A total of 58 patients were evaluated. Sputum was induced and sent for cytological examination. Patients were prescribed controller and reliever medications as per the GINA guidelines. Accordingly, subjects were divided into eosinophilic, neutrophilic, mixed granulocytic, and paucigranulocytic asthma. The response to treatment was classifed as poorly controlled based on ACT score. Results: Out of 58 patients, eosinophilic asthma (EA) was 24% and noneosinophilic 76% (NeuA 17%, MGA 23%, and PGA 36%). After treatment, 14 (24.13%) patients were found poorly controlled. Poor control was in 5.17% among EA and 18.97% in NEA phenotypes. Poor control was signifcantly higher in females, NeuA, and MGA. Peripheral eosinophilia afects control of asthma adversely. Conclusion: Pretreatment sputum analysis can predict the asthma control and steroid responsiveness. Mixed granulocytic asthma and NeuA are difcult to control, and PGA is the best responder. Keywords: Asthma, Eosinophilic, Mixed granulocytes, Noneosinophilic, Phenotypes, Paucigraulocytes. The Indian Journal of Chest Diseases and Allied Sciences (2022): 10.5005/jp-journals-11007-0052 A BBREVIATIONS USED IN THIS A RTICLE NEA = Noneosinophilic asthma; PGA = Paucigranulocytic asthma; MGA = Mixed granulocytic asthma; NeuA = Neutrophilic asthma; ICS = Inhaled corticosteroids; EA = Eosinophilic asthma; DTT = Dithiothreitol; ACT = Asthma control test. I NTRODUCTION Asthma is a disease of wide heterogeneity and variability. Although the majority of asthmatics can be controlled on standard therapy, a significant number of patients remain uncontrolled. Severe asthmatics are often referred to as corticosteroid-dependent, refractory, or corticosteroid-insensitive asthmatics. Induced sputum can be used to monitor the presence and severity of airway infammation in asthma. 1 Previous papers established a relationship between cytological type of infammation and the response to treatment with ICS in asthma. Sputum eosinophil levels of greater than 2–3% have been used to defne EA. 2 Noneosinophilic asthma with defining values of sputum neutrophilia ranging from as low as 40% to as high as >76% can be further diferentiated into paucigranulocytic, mixed granulocytic, or neutrophilic asthma. 3,4 While in eosinophilic asthma, the pathobiologic pathway is well- understood to be a Th2-mediated, neutrophilic asthma, usually a non-type-2 infammatory process, involves type-1 and/or type-17 infammations and is resistant to corticosteroids. 4,5 Technical requirements for sputum processing and cell counting may limit the feasibility of using sputum eosinophil counts in all clinical centers. Raised absolute eosinophil counts are reported as a predictor of response to treatment, but blood eosinophil counts do not necessarily refect sputum eosinophil counts also. Studies of the anti-IL-5 mepolizumab required only peripheral blood eosinophilia greater than or equal to 150 cells/μl at screening or 300 cells/μL in the preceding year. 6,7 Almost all patients with more than 400 cells/μl can be expected to have signifcant sputum eosinophils. 8 Paucigranulocytic asthma is an asthma phenotype with no evidence of elevated numbers of eosinophils or neutrophils in sputum or blood, is known as a “benign” asthma phenotype with better lung function and less frequency of severe refractory asthma, 9 whereas the mixed cellular phenotype was reported to be the most severe phenotype among the four groups. 10 Occasionally, NeuA together with PGA is referred to as “noneosinophilic asthma”. 3 The identification of the type of airway inflammation for making the optimal treatment decision can be very helpful. The 1 Department of Allergy, Asthma and Immunology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India 2,3 Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India 4 Department of Pathology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India Corresponding Author: Anil Kumar Jain, Department of Allergy, Asthma and Immunology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India, Phone: +91 9810796371, e-mail: akjain62@gmail.com How to cite this article: Jain AK, Sethi P, Janpathi B, et al. Sputum Infammatory Cells and their Impact on Asthma Control in Adults: A Prospective Study. Indian J Chest Dis Allied Sci 2022;64(3):192–195. Source of support: Nil Confict of interest: None