Decreased Eosinophil Counts and Elevated Lactate Dehydrogenase Predict Severe COVID-19 Patients with Underlying Chronic Airway Diseases

Abstract Background: Several predictors for the severity of coronavirus disease 2019 (COVID-19) have been reported, including decreased circulating lymphocytes and eosinophil counts. However, chronic airway inflammation characterized by accumulated lymphocytes or eosinophils may affect the pathogenesis of COVID-19. We aimed to investigate the predictors for the severity of COVID-19 in patients with chronic airway diseases.Methods: In this retrospective cohort study, we reviewed medical records of all laboratory-confirmed COVID-19 patients with chronic bronchitis, chronic obstructive pulmonary disease (COPD) and asthma admitted in Sino-French New City Branch of Tongji Hospital, a large regional hospital in Wuhan, China, from January 26th to April 3rd. The Tongji Hospital ethics committee approved this study.Results: There were 59 patients with underlying chronic airway inflammation including chronic bronchitis, COPD, and asthma. When compared with non-severe patients, severe patients were more likely to have decreased lymphocyte counts (0.6 vs. 1.1× 10⁹/L, p < 0.001), eosinopenia (< 0.02 × 10⁹/L, 73% vs. 24%, p < 0.001), increased lactate dehydrogenase (LDH) (471.0 vs. 230.0 U/L, p < 0.001) and elevated IL-6 level (47.4 vs. 5.7 pg/ml, p = 0.002) on admission. Eosinopenia and elevated LDH were significantly associated with disease severity in both univariate and multivariate regression models included the above variables. Eosinopenia was also an independent risk factor for mortality of this cohort in a multivariate model included the above variables. Moreover, eosinophil counts and LDH levels tended to return to normal range over time in both groups after treatment and severe patients recovered slower than non-severe patients, especially eosinophil counts.Conclusions: Eosinopenia and elevated LDH are potential predictors of disease severity in COVID-19 patients with underlying chronic airway diseases. Theses predictors may help clinicians identify the severe COVID-19 patients with chronic bronchitis, COPD, and asthma.

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Decreased eosinophil counts and elevated lactate dehydrogenase predict severe COVID-19 in patients with underlying chronic airway diseases

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-139704 ◽

2021 ◽

pp. postgradmedj-2021-139704

Author(s):

Dian Chen ◽

Shuchen Zhang ◽

Yuchen Feng ◽

Wenliang Wu ◽

Chenli Chang ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Chronic Bronchitis ◽

Disease Severity ◽

Eosinophil Count ◽

Treatment Effectiveness ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Airway Diseases ◽

New City ◽

Chronic Airway

BackgroundSeveral predictors of COVID-19 severity have been reported. However, chronic airway inflammation characterised by accumulated lymphocytes or eosinophils may affect the pathogenesis of COVID-19.MethodsIn this retrospective cohort study, we reviewed the medical records of all patients with laboratory-confirmed COVID-19 with chronic bronchitis, chronic obstructive pulmonary disease (COPD) and asthma admitted to the Sino-French New City Branch of Tongji Hospital, a large regional hospital in Wuhan, China, from 26 January to 3 April. The Tongji Hospital Ethics Committee approved this study.ResultsThere were 59 patients with chronic bronchitis, COPD and asthma. When compared with non-severe patients, severe patients were more likely to have decreased lymphocyte counts (0.6×10⁹/L vs 1.1×10⁹/L, p<0.001), eosinopaenia (<0.02×10⁹/L; 73% vs 24%, p<0.001), increased lactate dehydrogenase (LDH) (471.0 U/L vs 230.0 U/L, p<0.001) and elevated interleukin 6 level (47.4 pg/mL vs 5.7 pg/mL, p=0.002) on admission. Eosinopaenia and elevated LDH were significantly associated with disease severity in both univariate and multivariate regression models including the above variables. Moreover, eosinophil count and LDH level tended to return to normal range over time in both groups after treatment and severe patients recovered slower than non-severe patients, especially in eosinophil count.ConclusionsEosinopaenia and elevated LDH are potential predictors of disease severity in patients with COVID-19 with underlying chronic airway diseases. In addition, they could indicate disease progression and treatment effectiveness.

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Update on Clinical Inflammometry for the Management of Airway Diseases

Canadian Respiratory Journal ◽

10.1155/2013/602936 ◽

2013 ◽

Vol 20 (2) ◽

pp. 117-120 ◽

Cited By ~ 19

Author(s):

Parameswaran Nair

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Airway Inflammation ◽

Pulmonary Disease ◽

Treatment Strategies ◽

Chronic Obstructive ◽

Central Feature ◽

Obstructive Pulmonary Disease ◽

Cell Counts ◽

Airway Diseases ◽

Anti Inflammatory

Airway inflammation is a central feature of many airway diseases such as asthma, chronic bronchitis, bronchiectasis and chronic cough; therefore, it is only logical that it is measured to optimize its treatment. However, most treatment recommendations, including the use of anti-inflammatory therapies such as corticosteroids, are based on assessments of only airflow and symptoms. Over the past 10 years, methods have been developed to assess airway inflammation relatively noninvasively. Quantitative cell counts in sputum and the fraction of exhaled nitric oxide are the most validated tests. Judicious use of currently available drugs, such as corticosteroids, bronchodilators and antibiotics, and other anti-inflammatory therapies guided by sputum eosinophil and neutrophil counts, have been demonstrated to decrease exacerbations of asthma and chronic obstructive pulmonary disease, ameliorate cough, improve quality of life in patients with these diseases and is cost effective compared with treatment strategies based on guidelines that do not incorporate these measurements. Thus, it is unfortunate that this is not used more widely in the management of airway diseases, particularly in patients with severe asthma and chronic obstructive pulmonary disease who experience frequent exacerbations.

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Is there a difference between chronic airway inflammation in chronic severe asthma and chronic obstructive pulmonary disease?

Current Opinion in Allergy and Clinical Immunology ◽

10.1097/00130832-200502000-00014 ◽

2005 ◽

Vol 5 (1) ◽

pp. 77-83 ◽

Cited By ~ 29

Author(s):

Gaetano Caramori ◽

Anita Pandit ◽

Alberto Papi

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Airway Inflammation ◽

Pulmonary Disease ◽

Severe Asthma ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Chronic Airway

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Treatable traits: toward precision medicine of chronic airway diseases

European Respiratory Journal ◽

10.1183/13993003.01359-2015 ◽

2016 ◽

Vol 47 (2) ◽

pp. 410-419 ◽

Cited By ~ 372

Author(s):

Alvar Agusti ◽

Elisabeth Bel ◽

Mike Thomas ◽

Claus Vogelmeier ◽

Guy Brusselle ◽

...

Keyword(s):

Precision Medicine ◽

Social Impact ◽

Chronic Obstructive ◽

Biological Mechanisms ◽

Psychosocial Characteristics ◽

Obstructive Pulmonary Disease ◽

Airway Diseases ◽

Clinical Presentations ◽

Genetic Biomarker ◽

Chronic Airway

Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent chronic airway diseases that have a high personal and social impact. They likely represent a continuum of different diseases that may share biological mechanisms (i.e. endotypes), and present similar clinical, functional, imaging and/or biological features that can be observed (i.e. phenotypes) which require individualised treatment. Precision medicine is defined as “treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations”. In this Perspective, we propose a precision medicine strategy for chronic airway diseases in general, and asthma and COPD in particular.

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Use of Hyaluronic Acid (HA) in Chronic Airway Diseases

Cells ◽

10.3390/cells9102210 ◽

2020 ◽

Vol 9 (10) ◽

pp. 2210

Author(s):

Luis Máiz Carro ◽

Miguel A. Martínez-García

Keyword(s):

Hyaluronic Acid ◽

Chronic Obstructive ◽

Hydration Properties ◽

Water Binding ◽

Obstructive Pulmonary Disease ◽

Airway Diseases ◽

Copd Patients ◽

Surface Liquid ◽

Chronic Airway

Hyaluronic acid (HA) is a key component of the extracellular matrix of the lungs. A unique attribute of HA is its water-retaining properties, so HA has a major role in the regulation of fluid balance in the lung interstitium. Hyaluronic acid has been widely used in the treatment of eyes, ears, joints and skin disorders, but in the last years, it has been also proposed in the treatment of certain lung diseases, including airway diseases, due to its anti-inflammatory and water-binding capacities. Hyaluronic acid aerosol decreases the severity of elastase-induced emphysema in murine models, prevents bronchoconstriction in asthmatics and improves some functional parameters in chronic obstructive pulmonary disease (COPD) patients. Due to the protection of HA against bronchoconstriction and its hydration properties, inhaled HA would increase the volume of airway surface liquid, resulting in mucus hydration, increased mucous transport and less mucous plugging of the airways. In addition, it has been seen in human studies that the treatment with nebulised HA improves the tolerability of nebulised hypertonic saline (even at 6% or 7% of concentration), which has been demonstrated to be an effective treatment in bronchial secretion management in patients with cystic fibrosis and bronchiectasis. Our objective is to review the role of HA treatment in the management of chronic airway diseases.

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Decreased eosinophil counts and elevated lactate dehydrogenase predict severe COVID-19 patients with underlying chronic airway diseases

10.22541/au.159620968.84116387 ◽

2020 ◽

Author(s):

Dian Chen ◽

Lingling Yi ◽

Shuchen Zhang ◽

Yuchen Feng ◽

Wenliang Wu ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Airway Diseases ◽

Elevated Lactate ◽

Eosinophil Counts ◽

Elevated Lactate Dehydrogenase ◽

Chronic Airway

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Host–microbe interactions in distal airways: relevance to chronic airway diseases

European Respiratory Review ◽

10.1183/09059180.00011614 ◽

2015 ◽

Vol 24 (135) ◽

pp. 78-91 ◽

Cited By ~ 19

Author(s):

Clémence Martin ◽

Pierre-Régis Burgel ◽

Patricia Lepage ◽

Claire Andréjak ◽

Jacques de Blic ◽

...

Keyword(s):

Respiratory Diseases ◽

Disease Onset ◽

Chronic Obstructive ◽

Special Focus ◽

Post Transplantation ◽

Obstructive Pulmonary Disease ◽

Chronic Respiratory Diseases ◽

Airway Diseases ◽

Host Microbe Interactions ◽

Chronic Airway

This article is the summary of a workshop, which took place in November 2013, on the roles of microorganisms in chronic respiratory diseases. Until recently, it was assumed that lower airways were sterile in healthy individuals. However, it has long been acknowledged that microorganisms could be identified in distal airway secretions from patients with various respiratory diseases, including cystic fibrosis (CF) and non-CF bronchiectasis, chronic obstructive pulmonary disease, asthma and other chronic airway diseases (e.g.post-transplantation bronchiolitis obliterans). These microorganisms were sometimes considered as infectious agents that triggered host immune responses and contributed to disease onset and/or progression; alternatively, microorganisms were often considered as colonisers, which were considered unlikely to play roles in disease pathophysiology. These concepts were developed at a time when the identification of microorganisms relied on culture-based methods. Importantly, the majority of microorganisms cannot be cultured using conventional methods, and the use of novel culture-independent methods that rely on the identification of microorganism genomes has revealed that healthy distal airways display a complex flora called the airway microbiota. The present article reviews some aspects of current literature on host–microbe (mostly bacteria and viruses) interactions in healthy and diseased airways, with a special focus on distal airways.

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A study on overview of asthma-chronic obstructive pulmonary disease overlaps among patients with obstructive airway diseases

IP Indian Journal of Immunology and Respiratory Medicine ◽

10.18231/j.ijirm.2021.025 ◽

2021 ◽

Vol 6 (2) ◽

pp. 117-120

Author(s):

P Ajoy Kumar ◽

Are Suryakari Sreekanth

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Smoking History ◽

Chronic Obstructive ◽

Age Difference ◽

Obstructive Pulmonary Disease ◽

Asthmatic Patients ◽

Airway Diseases ◽

Obstructive Airway Diseases ◽

Chronic Airway

Asthma and chronic obstructive pulmonary disease (COPD) are different disease entities. They are both clinical diagnoses, with diagnostic tools to discriminate between one another.There is a need to re-evaluate the concept of asthma and chronic obstructive pulmonary disease (COPD) as separate conditions, and to consider situations when they may coexist, or when one condition may evolve into the other. A prospective study included 70 patients with chronic airway diseases who were classified into three groups (COPD, asthma and ACO). They were selected from Department of Pulmonary Medicine, Kurnool Medical College outpatient clinic during the period from January 2019 to December 2019, where patients with COPD and ACO were diagnosed according to GOLD guidelines and patients with asthma were diagnosed according to GINA guidelines. Patients enrolled in the study were subjected to full history taking, clinical examination, full laboratory examination, plain chest radiography, spirometry before bronchodilator and after bronchodilator administration (reversibility test) and sputum analysis for counting eosinophils cells. This study was conducted on 70 patients with chronic airway diseases (COPD, asthma and asthma COPD overlap) were selected. It included 47(67.1%) males and 23(32.8%) females. In our study, 30 (42.8%) patients as having COPD, 19(27.1%) patients were diagnosed as having asthma and 21(30%) patients were diagnosed as having ACO. Regarding the age difference between groups, it was found that patients who were diagnosed as having ACO were older than asthmatic patients with mean age of 49.43±5.83 and 47.23±6.73years, respectively. The men age of patients with COPD was 57.32±6.74 which was older than both ACO and asthmatic patients. ACO represents a large percentage among patients with obstructive airway diseases. It shares some features of asthma such as atopy and positive sputum eosinophilia, and some features of COPD like old age of presentation and positive smoking history.

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