Sputum Inflammatory Cells and their Impact on Asthma Control in Adults: A Prospective Study

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 inflammation 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 inflammatory 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 classified 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 significantly higher in females, NeuA, and MGA. Peripheral eosinophilia affects control of asthma adversely. Conclusion: Pretreatment sputum analysis can predict the asthma control and steroid responsiveness. Mixed granulocytic asthma and NeuA are difficult to control, and PGA is the best responder.