Automated eosinophilia: a marker for asthma severity. Is it a gauge for anti-inflammatory therapy?

Current therapy of asthma is based on its clinical severity, which mainly depends on symptoms and peak flow rate, and not on any laboratory criterion. The objective of this study is to investigate the value of total peripheral eosinophil count in asthma assessment through its correlation with the clinical severity. One hundred and seventy eight asthmatics referred to asthma and pediatric clinics were reviewed for complete history and examination. Clinical severity was assessed using symptoms criteria based on the global strategy for asthma management and prevention. Total peripheral eosinophil count by Cell-Dyne 3500 automated counter[registered] and asthma severities were analyzed for any significant association. Asthmatics were aged between 6 months and 70 years [mean = 17.5 years] and males formed 52%. Severity groups are intermittent 22 [12%], mild-persistent 87 [49%], moderate-persistent 56 [31.5%] and severe-persistent 13 [7%]. Total peripheral eosinophil count ranged between 10 and 2470 cells/mm[3] [mean=546 +/- SD]. Eosinophilia [>450 cells/mm] was found in 53% of cases, more in the persistent type [60%]. In each clinical group, total peripheral eosinophil count and their means showed a very significant positive correlation with increased asthma severity [P<0.001] with a high linear trend [P<0.001]. Additionally, total peripheral eosinophil count correlates significantly with a history of other allergic illnesses [P<0.001]. This data supports the use of total peripheral eosinophil count as an accumulative objective marker for asthma severity. In asthmatics, eosinophilia suggests higher severity and/or other allergic illnesses. Optimally, in those, anti-inflammatory drugs would be required to control asthma

How the discrepancy between symptoms and peak expiratory flow rate influences evaluation of asthma severity

Recent asthma guidelines recommend the assessment of severity levels based on the most severe symptoms and peak expiratory flow rate [PEFR]. Discrepancies are frequently encountered in the use of these variables in determining the severity levels of asthmatics. The objective of this study was to determine the difference in asthma severity levels as assessed by either symptoms alone or by PEFR alone, as compared with the assessment by the asthma guidelines. Patients and Severity levels that were determined by recent asthma guidelines for 60 asthmatic patients were reassessed, based on symptoms alone and PEFR alone. They were compared for any significant differences to the asthma guidelines. Asthmatics were aged between 15 and 70 [mean 34] years, and 63.8% were females. Severity levels by symptoms alone were different from the guidelines in 27 cases [45%]. Of these, 89% showed a tendency toward higher severity levels. Severity levels by PEFR alone were different in only three cases [5%]. In both comparisons, differences of severity levels were significant [P<0.0001], but assessment by symptoms alone showed more deviation [chi2=162.1] than PEFR alone [chi2=73.1]. The study documented significant discrepancies in asthma severity assessed by symptoms alone and PEFR alone, when compared to the recent asthma guidelines. Severity assessed by symptoms alone showed lower levels, and the use of PEFR tended to categorize some asthmatics into a more severe level