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et al. 1999; Giannini, Di Franco et al. 2000; Jatakanon, Lim et al. 2000; Green, Brightling et
al. 2002). The results seen across all the studies suggest that the inflammation measured in
this way reflects current asthma control rather than grading chronicity or severity per se.
As indicated in the biopsy and lavage studies above, increased neutrophil counts may also be
a marker for poorly responsive disease. In severe asthmatics, there were more neutrophils and
less eosinophils compared to mild asthmatics (Loh, Kanabar et al. 2005) and neutrophilic
inflammation was dominant in the minority of subjects from over 250 adult asthmatics who
demonstrated less corticosteroid response (Green, Brightling et al. 2002). Both eosinophilic
inflammation and neutrophilic inflammation were found to independently contribute to
abnormalities of FEVr in 205 adult asthmatics (Woodrufl Khashayar et d. 2001). Treating
the neutrophil count resulted in better control than monitoring lung function or symptoms
(Chlumsky, Striz et al.20O6). Neutrophils were also increased acutely, making up more than
757o of the sputum cells in 10 of 18 adult subjects during acute asthma while eosinophils
made up more thanT1Vo of the cells in only three subjects (Fahy, Kim et al. 1995).
1.6.4 (ii) Induced sputum in children
Sputum induction in children developed more recently and therefore in some of the studies
from the 2000s it has been combined with NO measurement. As this will be covered in depth
in later parts of the thesis, I will only discuss the cell and cytokine inflammatory markers
from induced sputum in this section. The technique has been used for getting bacterial, viral,
fungal and tuberculosis cultures to determine infective aetiology (Merrick, Sepkowitz et al.
L997; Utsunomiya, Ahmed et al. 1998; Ordonez, Henig et al. 2003; kiso, Mudido et al. 2005;
Ratjen 2W6). Using induced sputum to assess inflammatory disease was first described in
1980 when presence of an eosinophilia was used to diagnose co-existent asthma in children
with CF was investigated (Sly and Hutchison 1980). In 1995 sputum and nasal smears taken
from I 11 young children presenting acutely with wheeze showed increased eosinophils,
neutrophils and basophils in those deemed 'asthmatic' compared to those who were wheezy
but unresponsive to asthma treatment (Twaddell, Gibson et al. 1996). Increased eosinophils at
3.8Vo and epithelial cells at tl.S%o were seen in 16 children with uncontrolled asthma
compared to 15 with controlled asthma at 2.5Vo and lO.SVo and 72 healthy non-asthmatic
children at0.3Vo and l.5Vo respectively (Cai, Carty et al. 1998). Mast cells, prominent in adult
asthma studies, were found in only 4 of the 42 asthmatic children (Cai, Carty et al. 1998). An
increase in eosinophil percentage and ECP was seen in 50 asthmatic children compared to
fifteen children with chronic bronchitis (CB) and 25 healthy children (Yazicioglu, Ones et al.
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