Objective To improve the diagnosis and treatment of pulmonary infiltration with eosinophilia (PIE). Methods Patients who were diagnosed with PIE in the First Affiliated Hospital of Guangzhou Medical University from January 2004 to December 2013 were recruited and retrospectively analyzed. Data of etiology, clinical manifestation, imaging and pathological features were recorded. Results pulmonary eosinophilic granuloma (PEG) (n=2), eosinophilic granulomatosis with polyangiitis (EGPA) (n=7), Löffler syndrome (n=4), allergic bronchopulmonary aspergillosis (ABPA) (n=16), and chronic eosinophilic pneumonia (CEP) (n=19). There were 27 males and 21 females. 47.9% of the PIE patients were diagnosed as asthma and treated with regular treatment but had not been controlled well. PEG was characterized with wheeze and anhelation in clinical manifestations, unelevated blood eosinophil counts and percentage, significant small airway abnormalities in lung function, diffuse pneumonectasis in Chest CT, and appearance of eosinophil cells in alveole. EGPA shows dyspnea and cough in clinical manifestations, as well as other organs function damaged, unelevated blood eosinophil counts and percentage, significant FEV1/FVC and small airway abnormalities in lung function, tree-in-bud in Chest CT, appearance of eosinophilic granuloma outside blood vessels. Löffler syndrome also showed cough, shorter course of disease, normal lung function and diffusion. ABPA showed wheeze and cough, 31.3% of them with hemoptysis, normal blood eosinophil count, central bronchiectasis in Chest CT. CEP also showed dyspnea and cough. 21.1% of CEP patientshad chest pain, increasing sputum eosinophil percentage compare with blood eosinophil percentage, and small airway abnormalities in lung function. Conclusions Most of PIE patients are diagnosed as asthma but haven’t gotten well controlled under the regular anti-asthmatic treatment. Patients with PIE have increasing eosinophil counts and decreasing lung function. The diagnosis of PIE still depends on clinical manifestation, laboratory test, imaging and pathological examination.
ObjectiveTo summarize the clinical manifestations, diagnosis and treatments of chronic eosinophilic pneumonia (CEP).MethodsThe clinical and pathological data of five patients with CEP diagnosed in this hospital between January 2011 and January 2015 were retrospectively analyzed.ResultsThere were five CEP cases including two males and three females, and one case with allergic rhinitis, two cases with bronchial asthma, two cases with allergic history, and one case with allergic skin rash. The main clinical manifestations were fever, cough, expectoration, shortness of breath and chest pain, and often accompanied by fatigue, anorexia and weight loss. The main signs included moist rales, scattered wheeze and crackles. There were significantly increased peripheral blood eosinophils count, the proportion of eosinophils, and the proportion of eosinophils in bronchoalveolar lavage fluid in all five cases. The main imaging features were airway infiltration, real change shadow and ground glass shadow. All of five cases were treated with glucocorticoid, and one of them relapsed during follow-up.ConclusionsThe onset of CEP is insidious. The clinical manifestations of CEP are lack of specificity, and often associate with asthma and allergic dermatitis. Eosinophils significantly increase in peripheral blood and bronchoalveolar lavage fluid in most of CEP patients. The typical image is peripheral and subpleural distribution of lung infiltrates.
ObjectiveTo explore the clinical characteristics of idiopathic hypereosinophilic syndrome (IHES), and improve the early diagnosis and treatment of such diseases.MethodsThe clinical diagnosis and treatment data were retrospectively analyzed from the patients with confirmed IHES hospitalized in China-Japan Friendship Hospital between September 2010 to May 2018.ResultsFifteen patients were included. There were 3 women and 12 men in the study, with an average age of 53.7±21.3 years. Eleven patients had respiratory problems, with an average course of 7 months. Most lesions occurred in both lungs. Patchy distribution, ground glass opacity, pleural effusion and mediastinal lymph node enlargement were common in the chest computed tomography. Serum total IgE was significantly increased. Four patients had other systems involved rather than respiratory system. One of them had digestive problems and another 3 had skin diseases. There was a significant increase in eosinophils in peripheral blood, bone marrow and histopathology, the same as eosinophils in sputum, pleural effusion, and bronchoalveolar lavage fluid. Hypoxemia was common in patients with respiratory problems. The blood eosinophil and total IgE were reduced after glucocorticoid treatment, and the hypoxemia was significantly improved.ConclusionsThe clinical symptoms, signs and image of chest computed tomography are not specific in IHES, so the rate of misdiagnosis and wrong diagnosis is high. This disease involves many organs or systems, so the pathological examination should be completed as soon as possible to make a clear diagnosis to prevent further damage. Glucocorticoid treatment is effective in this disease.
ObjectiveTo explored the influence of disease changes, weight gain, eosinophil levels and other factor in pregnancy women with asthma. MethodsCase records of gestational asthma patients produced in the obstetrics department of Peking University People's Hospital from October 2010 to October 2020 were collected, and refer to electronic medical records of clinics (pre-pregnancy and pregnancy). According to the disease control (asthma related unplanned respiratory clinics, emergency or hospitalization), patients were divided into pregnancy stable group and pregnancy fluctuation group. The basic characteristics, pre-pregnancy asthma control, weight gain during pregnancy and peripheral blood eosinophil level before labor were retrospectively analyzed. The cause of asthma attacks, clinical characteristics and distribution of gestational time in pregnancy fluctuations were described. Peripheral blood eosinophil levels in different period during pregnancy in the stable group were analyzed. ResultsTotally 124 cases of natural pregnancy singleton were enrolled in the study. The age was (32.3±3.9) years old. There were 71 patients in stable group and 53 patients in fluctuation group. The proportion of pre-pregnancy instability in the fluctuating pregnancy group was higher than that in the stable pregnancy group (P<0.05). The proportion of intermittent medication before pregnancy was higher in the fluctuating pregnancy group than in the stable pregnancy group (P<0.05). Peripheral blood eosinophil count before labor and the number of cases with eosinophil count≥0.15×109/L before labor were higher in the fluctuation group (all P<0.05). The proportion of hypertentive diseases in pregnancy and fetal distress in uterus were higher in the fluctuation group (all P<0.05). The common cold was the common trigger factor (38.2%) and asthma recurrences occur between 13 and 36 weeks of gestation (65.8%) in fluctuation group. In further analysis of subgroup (the stable group), peripheral blood eosinophil count in early pregnancy (P<0.05) and pregnant metaphase (P<0.05) were higher than before delivery. The number of cases with eosinophil count>0.15×109/L in pregnant metaphase (P<0.05) was higher than before delivery. ConclusionsAsthma fluctuates during pregnancy is associated with adverse maternal and fetal outcomes. It is very important and critical that asthma control before pregnancy, weight gain management and eosinophil level monitoring of patients with asthma during pregnancy. The whole management is imperative in women with asthma during pregnancy.
Objective To evaluate the correlation between blood eosinophilia and clinical characteristics, readmission rate and mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP, and CBM databases were searched until October 31, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the bias risk of the included studies. Meta-analysis was conducted by Rev Man v.5.4. Results Finally, 76 observational studies met the inclusion criteria, including 15 English literatures and 61 Chinese literatures. There were 8240 patients (34.20%) in the eosinophilia group (EOS≥2%) and 15854 cases (65.8%) in the eosinophil normal group (EOS<2%). Results of meta-analysis: (1) Inflammatory Index: eosinophilia group had lower C-reactive protein [MD=–8.44, 95%CI (–10.59, –6.29), P<0.05], and lower neutrophil to lymphocyte ratio [MD=–2.47, 95%CI (–3.13, –1.81), P<0.05]. (2) Hospitalization: eosinophilia group had shorter hospital stay [MD=–2.23, 95%CI (–2.64, –1.81), P<0.05] and lower in-hospital mortality [OR=0.41, 95%CI (0.31, 0.53), P<0.05], lower mechanical ventilation rate [OR=0.59, 95%CI (0.47, 0.75), P<0.05], lower hormone use rate [OR=0.91, 95%CI (0.85, 0.96), P<0.05]. (3) Follow-up results: eosinophilia group had a lower rate of readmission at 1 year [OR=0.78, 95%CI (0.66, 0.92), P<0.05] and a lower rate of death at 1 year [OR=0.78, 95%CI (0.62, 0.97), P<0.05]. Conclusions AECOPD patients with eosinophilia group were characterized by lower inflammatory indicators, shorter hospital stay, shorter in-hospital mortality, lower mechanical ventilation rate, lower hormone use rate, lower rate of acute exacerbation readmission, lower mortality rate and lower rate of follow-up after 1 year. This kind of patients with mild disease, good treatment effect, low risk of acute exacerbation.
ObjectiveTo investigate factors influencing the results of bronchodilator reversibility tests (BDT) in mild to moderate asthma, and to develop a model predicting the result of BDT in this population. Methods A cross-sectional study was designed to recruit patients with forced expiratory volume in the first second (FEV1) ≥ 70% predicted from the Australasian Severe Asthma Network during 2014 to 2021, whose asthma diagnosis was confirmed by a positive bronchial challenge test. Structural questionnaires, BDT, fractional exhaled nitric oxide (FeNO), induced sputum and peripheral blood sampling were conducted. Patients were further divided into positive group and negative group according to their BDT result. Then the comparative analysis between two groups, correlation analysis, and multivariate logistical regression were performed. Logistic models for predicting BDT result were developed using variables screened through LASSO regression. Results A total of 334 patients were included. Compared with the BDT negative group (n=240), the BDT positive group (n=94) was found to have worse airway obstruction in lung function, asthma control and quality of life, higher eosinophil counts in both peripheral blood and induced sputum, and higher FeNO. According to the multivariate regression, the positive BDT results significantly correlated with Asthma Control Questionnaire score, Asthma Questionnaire of Life Quality score, FEV1%pred, MMEF%pred, FEV1/FVC, blood and sputum eosinophil counts and FeNO. A total of 326 patients were included in the training set, and FEV1%pred, MMEF%pred, FEV1/FVC, smoking pack years, blood and sputum eosinophil counts and FeNO were then screened out by LASSO regression as stable predictors. The areas under the receiver operating characteristic curve of the 3 prediction models (P<0.001) constructed using the variables above ranged from 0.810 to 0.834. Internal validation was performed, and both the discrimination (0.810, 0.834 and 0.812, respectively) and the calibration (0.135, 0.133 and 0.192, respectively) of the models were acceptable. Conclusion The BDT results of patients with mild to moderate asthma were associated with asthma control, lung function, systemic or airway eosinophilia and FeNO, and models including lung function, eosinophils, and FeNO, etc. could predict the BDT results well.
Objective To investigate the risk factors, clinical characteristics and prognostic factors of venous thrombosis (and pulmonary embolism) in patients with idiopathic hypereosinophilia (IHE) so as to provide a theoretical basis for clinical prevention of venous thrombosis and improve prognosis.Methods Thirty-nine patients with IHE admitted to West China Hospital of Sichuan University from January 2010 to January 2022 were collected in this retrospective case-control study to explore the risk factors of venous thrombosis (including pulmonary embolism) and thrombosis recurrence after treatment. Results There were 17 (43.5%) patients combined with venous thrombosis of 39 patients with IHE. In the patients with vascular involvement, pulmonary embolism was the initial expression of IHE accounted for 29% (5/17). patients of IHE with pulmonary embolism were younger [44 (24.5 - 51.0) vs. 56 (46.3 - 67.8) year, P=0.035] and had higher peak absolute eosinophil counts [11.7 (7.2 - 26.5)×109/L vs. 3.8 (2.9 - 6.7)×109/L, P=0.020] than those without pulmonary embolism. After a mean follow-up of 13 months (2 - 21 months), thrombosis recurred in 35.3% (6/17) of patients. Persistent increasing in eosinophils (>0.5×109/L) was an independent risk factor for thrombus recurrence (odds ratio 13.33, 95% confidential interval 1.069 - 166.374). Conclusions Thrombosis is a common vascular impaired complication in IHE , and increased eosinophilia is a risk factor for thrombosis and thrombus recurrence after therapy. Controlling and monitoring the eosinophilic cell levels in patients with IHE may avoid severe comorbidities.