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. 2004 Jun;59(6):488–493. doi: 10.1136/thx.2003.016899

Can endobronchial biopsy analysis be recommended to discriminate between asthma and COPD in routine practice?

A Bourdin 1, I Serre 1, H Flamme 1, P Vic 1, D Neveu 1, P Aubas 1, P Godard 1, P Chanez 1
PMCID: PMC1747055  PMID: 15170031

Abstract

Background: International guidelines stress the importance of accurately discriminating between asthma and chronic obstructive pulmonary disease (COPD). Although characteristic pathological features have been described for both conditions, their discriminatory power has never been systematically assessed.

Methods: Endobronchial biopsy (EBB) specimens from patients with a clear clinical diagnosis of asthma and COPD (50 per group) were examined by three pathologists in a double blind manner. They were asked to propose a pathological diagnosis of either asthma or COPD and to analyse qualitatively the most frequent abnormalities reported in the literature.

Results: The sensitivity and specificity of EBB ranged from 36% to 48% and from 56% to 79%, respectively. Eosinophils strongly biased the pathological diagnoses in favour of asthma, whereas their estimated prevalence was similar (11–37% in asthma and 13–41% in COPD). Metaplasia (11–39% in COPD, 1–18% in asthma) and epithelial inflammation (28–61% in COPD, 11–38% in asthma) tended to be specific to COPD, whereas epithelial desquamation (80–98% in asthma, 61–88% in COPD) and basement membrane thickening (71–94% in asthma, 53–88% in COPD) tended to be associated with asthma. There was acceptable intra- and inter-observer agreement only for metaplasia and epithelial eosinophils.

Conclusions: Specific histopathological features of asthma and COPD probably exist, but current routine analysis procedures to assess EBB specimens are not sufficiently discriminatory. This might be rectified by improving pathological definitions.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Carayol Nathalie, Campbell Alison, Vachier Isabelle, Mainprice Brigitte, Bousquet Jean, Godard Philippe, Chanez Pascal. Modulation of cadherin and catenins expression by tumor necrosis factor-alpha and dexamethasone in human bronchial epithelial cells. Am J Respir Cell Mol Biol. 2002 Mar;26(3):341–347. doi: 10.1165/ajrcmb.26.3.4684. [DOI] [PubMed] [Google Scholar]
  2. Chanez P., Vignola A. M., O'Shaugnessy T., Enander I., Li D., Jeffery P. K., Bousquet J. Corticosteroid reversibility in COPD is related to features of asthma. Am J Respir Crit Care Med. 1997 May;155(5):1529–1534. doi: 10.1164/ajrccm.155.5.9154853. [DOI] [PubMed] [Google Scholar]
  3. Dunnill M. S., Massarella G. R., Anderson J. A. A comparison of the quantitative anatomy of the bronchi in normal subjects, in status asthmaticus, in chronic bronchitis, and in emphysema. Thorax. 1969 Mar;24(2):176–179. doi: 10.1136/thx.24.2.176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. James Alan L., Maxwell Peta S., Pearce-Pinto Gladys, Elliot John G., Carroll Neil G. The relationship of reticular basement membrane thickness to airway wall remodeling in asthma. Am J Respir Crit Care Med. 2002 Dec 15;166(12 Pt 1):1590–1595. doi: 10.1164/rccm.2108069. [DOI] [PubMed] [Google Scholar]
  5. Jeffery P. K. Remodeling in asthma and chronic obstructive lung disease. Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 2):S28–S38. doi: 10.1164/ajrccm.164.supplement_2.2106061. [DOI] [PubMed] [Google Scholar]
  6. Jeffery Peter, Holgate Stephen, Wenzel Sally, Endobronchial Biopsy Workshop Methods for the assessment of endobronchial biopsies in clinical research: application to studies of pathogenesis and the effects of treatment. Am J Respir Crit Care Med. 2003 Sep 15;168(6 Pt 2):S1–17. doi: 10.1164/rccm.200202-150WS. [DOI] [PubMed] [Google Scholar]
  7. Kramer M. S., Feinstein A. R. Clinical biostatistics. LIV. The biostatistics of concordance. Clin Pharmacol Ther. 1981 Jan;29(1):111–123. doi: 10.1038/clpt.1981.18. [DOI] [PubMed] [Google Scholar]
  8. Lacoste J. Y., Bousquet J., Chanez P., Van Vyve T., Simony-Lafontaine J., Lequeu N., Vic P., Enander I., Godard P., Michel F. B. Eosinophilic and neutrophilic inflammation in asthma, chronic bronchitis, and chronic obstructive pulmonary disease. J Allergy Clin Immunol. 1993 Oct;92(4):537–548. doi: 10.1016/0091-6749(93)90078-t. [DOI] [PubMed] [Google Scholar]
  9. Layfield Lester J., Jones Claudia, Rowe Leslie, Gopez Evelyn V. Institutional review of outside cytology materials: a retrospective analysis of two institutions' experiences. Diagn Cytopathol. 2002 Jan;26(1):45–48. doi: 10.1002/dc.10022. [DOI] [PubMed] [Google Scholar]
  10. Ordoñez C., Ferrando R., Hyde D. M., Wong H. H., Fahy J. V. Epithelial desquamation in asthma: artifact or pathology? Am J Respir Crit Care Med. 2000 Dec;162(6):2324–2329. doi: 10.1164/ajrccm.162.6.2001041. [DOI] [PubMed] [Google Scholar]
  11. Saetta M., Di Stefano A., Turato G., Facchini F. M., Corbino L., Mapp C. E., Maestrelli P., Ciaccia A., Fabbri L. M. CD8+ T-lymphocytes in peripheral airways of smokers with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998 Mar;157(3 Pt 1):822–826. doi: 10.1164/ajrccm.157.3.9709027. [DOI] [PubMed] [Google Scholar]
  12. Salvato G. Some histological changes in chronic bronchitis and asthma. Thorax. 1968 Mar;23(2):168–172. doi: 10.1136/thx.23.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Sont J. K., Willems L. N., Evertse C. E., Hooijer R., Sterk P. J., van Krieken J. H. Repeatability of measures of inflammatory cell number in bronchial biopsies in atopic asthma. Eur Respir J. 1997 Nov;10(11):2602–2608. doi: 10.1183/09031936.97.10112602. [DOI] [PubMed] [Google Scholar]
  14. Sterk P. J., Fabbri L. M., Quanjer P. H., Cockcroft D. W., O'Byrne P. M., Anderson S. D., Juniper E. F., Malo J. L. Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:53–83. [PubMed] [Google Scholar]
  15. Vignola A. M., Bousquet J., Chanez P., Gagliardo R., Merendino A. M., Chiappara G., Bonsignore G. Assessment of airway inflammation in asthma. Am J Respir Crit Care Med. 1998 May;157(5 Pt 2):S184–S187. doi: 10.1164/ajrccm.157.5.rsaa-3. [DOI] [PubMed] [Google Scholar]
  16. Walter S. D. Measuring the reliability of clinical data: the case for using three observers. Rev Epidemiol Sante Publique. 1984;32(3-4):206–211. [PubMed] [Google Scholar]

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