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onchial hyper-responsiveness (Reichenbach, Jarisch et al. 2002). Neither eosinophil
numbers nor ECP levels could predict the intensity of response to bronchial inflammatory
reaction in 46 house dust mite allergic children (Vila-Indurain, Munoz-l-apez et d. 1999).
Negative findings also occurred in studies into the leukotrienes. While there were significant
associations between lung function parameters and urinary LTEa, it did not distinguish
between groups of 49 mild and 3l moderate to severe asthmatics (Severien, Attlich et al.
2000). A single urine sample did not predict bronchial hyper-responsiveness or degree of
airflow obstruction in 41 asthmatics (Smith, Hawksworth et al. 1992). There was no increase
in LTCa, LTD4 or LTE4 in urine after an exercise challenge in adults (Taylor, Wellings et al.
1992). The measurement of urinary EDN in children with either acute or chronic asthma,
lower or upper respiratory tract infections or controls did not show significant differences
between these groups (Oymar and Bjerknes 2001).
So in all age groups blood and urine inflammatory parameters have failed to show consistent
discrimination between asthma and other allergic diseases, and in children between asthma
and other respiratory diseases, and also failed to determine asthma severity. The cells and
proteins in these systemic samples may not necessarily indicate what is happening in the
lungs as they are being measured from more distant sites. In addition, the measurement made
from blood samples by the time these reach the laboratory is made up of both the circulating
ECP and what is released from the eosinophils after the blood has been drawn into the tube
(Venge 1995). While these are easier samples to obtain with the benefit of fewer side effects
than sampling nonproductive respiratory secretions directly, blood testing is still perceived as
an invasive procedure and urine samples can be tiresome to obtain, particularly in children.
1.6.6 Comparison of intlammation results between the different samples
Comparisons have been made between the levels of inflammatory parameters obtained
through the different tissue or fluid samples. The cellular composition of induced sputum
correlates well with bronchoalveolar lavage and wash, but to a lesser extent with bronchial
biopsies (Fahy, Wong et al. 1995; Maestrelli, Saetta et al. 1995; Grootendorst, Sont et al.
1997; Keatings, Evans et al. 1997; Pizzichini, Pizzichini et al. 1998). For example, mast cells
usually make up only a small proportion of cells recovered by lavage but are as much as 20Vo
of the inflammatory cells in biopsy studies (Dunnill 1960; Foresi, Bertorelli et al. 1990).
Likewise there are more basophils in the biopsy specimens than in the lavage specimens
(Koshino, Teshima et al. 1993; Macfarlane, Kon et al. 2000). On the other hand as induced
sputum is rich in neutrophils and eosinophils but poor in lymphocytes, the origin of the
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