Airway eosinophilic inflammation, epithelial damage, and bronchial hyperresponsiveness in patients with mild-moderate, stable asthma

Allergic asthma is characterized by chronic recruitment of eosinophils in the airways. Once activated, eosinophils release toxic products, including eosinophil cationic protein (ECP), able to damage airway epithelial cells. To test the hypothesis that also in mild-moderate stable asthma, a significant eosinophil activation could occur, we studied 25 asthmatic patients (34 ± 19 years old), of whom 18 were allergic (27 ± 12 years) and seven nonallergic (42 ± 10 years), with FEV₁ values ≥ 70% of predicted, and eight normal volunteers (controls, 33 ± 11 years). All subjects underwent methacholine (MCh) challenge on the first visit, and bronchoalveolar lavage (BAL) on the second visit (approximately 3-4 days later). BAL cells were counted and albumin (Alb) (as index of protein dilution in BAL fluid) and ECP levels (as index of eosinophil activation) in BAL fluid were measured. As compared to controls, a significant increase in BAL eosinophil and in BAL epithelial cell numbers was observed in asthmatic patients (P > 0.05, each comparison), with no differences between the two asthmatic patient subgroups. Detectable ECP levels (> μg/1) were found in BAL of 18 asthmatic patients (14 allergic and four nonallergic asthmatic patients), while Alb levels were measurable in 25 BAL fluids and found to be similar in controls and asthmatic patients, and in the two asthmatic patient subgroups (P > 0.05, each comparison). In BAL of asthmatic patients, positive correlations were found between eosinophil numbers and 1 ) ECP/Alb levels (r = 0.50, P = 0.020); 2) epithelial cell numbers (r = 0.50, P = 0.014). In asthmatic patients, a significant negative correlation was found between bronchial reactivity to MCh (log Pd₁₅) and ECP/Alb levels in BAL fluid (r =-0.6, P = 0.005), whereas no correlation was found between log Pd₁₅ MCh and BAL eosinophil or epithelial cell number (P > 0.1, each correlation). These data suggest that bronchial eosinophil recruitment and activation may occur also in mild moderate stable asthma and that bronchial epithelium damage and airway responsiveness may be partially associated with the eosinophilic inflammatory reaction.