Level of eosinophil cationic protein in sputum of chemical warfare victims

Considering fair response to inhaled corticosteroids and reports of severe air way hyper responsiveness in chemical warfare victims [CWV], a role for eosinophilic inflammation [i.e. asthma] was postulated. The objective of this study was to determine the presence of eosinophilic inflammation in CWV by evaluation of Sputum cellularity and eosinophil cationic protein [ECP]. Forty CWV and 15 control subjects entered this cross sectional study. Demographic data, dyspnea severity scale, spirometry results and 6 min walk test were determined. Sputum was collected with inducing by nebulizing hypertonic saline and analyzed for total inflammatory cell count, the cellular differential count and ECP level. Control group was normal volunteers with PC[20] more than 8 mg/ml. Mean +/- SD of eosinophil percentage [11.7 +/- 11.1%] and ECP level in sputum of CWV [46.1 +/- 19.5 ng/ml] were significantly more than control group. Regression analysis showed significant correlation between ECP level and percentage of eosinophils in sputum [r= +0.43, P< 0.01]. ECP level of CWV subjects with obstructive pattern did not show any significant difference from CWV with normal spirometry. ECP level in CWV subjects who revealed more than 12% improvement in forced expiratory volume in one second [FEV1] was significantly higher than CWV who had improvement less than 12% [P= 0.01]. BO and asthma as final clinical diagnosis of CWV did not show any significant difference of sputum ECP. Bronchial inflammation in different types of pulmonary complication of CWV is eosinophil dependent. ECP level of sputum in CWV could guide physician to select CWV who would respond to corticosteroids

Anemia in COPD patients and its relation to serum levels of erythropoietin

Although chronic obstructive pulmonary disease [COPD] is traditionally associated with polycythemia, its systemic inflammatory components can interfere with erythropoietin and result in anemia of chronic disease. We assessed the frequency of anemia and its relation to serum erythropoietin [EPO] levels and severity of the disease in a group of COPD patients. Eighty patients with the mean age of 66.48 +/- 11.55 years and mean forced expiratory volume in first second [FEV1] of 45.14 +/- 16.88% predicted were enrolled in this study. Severity of the disease was defined according to the global initiative for chronic obstructive lung disease [GOLD] guidelines. Hemoglobin and erythropoietin levels were assessed in all patients. Anemia of chronic disease was present in 13 of 80 patients [16%]. The mean serum levels of EPO were 59 +/- 203 [SD] micro/l and 70.3 +/- 255 [SD] micro/l in anemic and nonanemic COPD patients, respectively. There was no significant difference between the two groups [p=0.13]. A significant correlation was seen between hemoglobin and serum EPO in all COPD and nonanemic patients [r = - 0.86, p < 0.001 and r = - 0.28, p = 0.02]. No significant correlation was seen between hemoglobin and serum erythropoietin levels in the anemic group [r = 0.07, p = 0.82]. This study showed that anemia occurred relatively frequently in COPD patients. In addition to erythropoietin resistance, other factors are probably involved in the pathogenesis of anemia in these patients

Inhaled corticosteroids and bone density in chemical warfare patients with pulmonary complications

The most effective treatment in chemical warfare victims [CWV] suffering from severe long-term obstructive pulmonary disease is inhaled corticosteroids [ICS] and long acting beta-2 agonists. Study results on adverse effects of ICS on bone were conflicting. In the present study, we evaluated the effect of ICS on bone mineral density [BMD] of CWV and possible effects of chemical warfare agents on BMD. Thirty-five CWVs entered this study. Demographic and spirometric data [including staging of severity of lung disease] and BMD results as shown by z-score and t- score measured in lumbar and femoral regions were evaluated in this group of patients. In comparison, 75 normal subjects as controls were included in this study and their BMD results were compared with those of the case group. The mean age in CWVs was 41.40 +/- 7.74 years, which showed no significant difference with that of the control group. According to spirometric data, CWVs had obstructive lung disease. BMD in lumbar and femoral regions in the case group was 1.14 +/- 0.14 and 0.93 +/- 0.13 g/cm[2] respectively, which showed no significant difference with that of the control group. Regression analysis showed that BMD in the femoral region was correlated with forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC] and t-score in lumbar region was correlated with FEV1. BMD in the femoral region decreased as the severity of bronchial obstruction increased [0.99 +/- 1.07 g/cm[2] in mild form to 0.75 +/- 0.27 in severe form; F=3.91, P=0.03] but in the lumbar region BMD had no significant correlation with severity of bronchial obstruction. BMD did not decrease during long-term therapy with ICS in CWVs. Severity of bronchial obstruction can be an important risk factor