Exploring EGPA: Clinical perspectives on peripheral eosinophilia and lung involvement with real-life data.
Keywords:
eosinophilia, pulmonary disorders, EGPA, peripheral eosinophilia, differential diagnosis, eosinophilic vasculitis, real-life data, egpa management, lung involvement in vasculitis, diagnostic challenges in egpaAbstract
Introduction: The role of eosinophils in acute and chronic lung diseases becomes more evident day by day. The aim of this study is to analyze the guiding role of peripheral eosinophilia in the diagnosis of lung diseases and to present pulmonologists' perspective on EGPA with old and new diagnostic criteria through real-life data.
Patients and Methods: In this retrospective observational cohort, the files of patients who presented to the chest diseases department with pulmonary symptoms and peripheral eosinophilia between 2017-2023 were investigated. The diagnoses of the patients and their eosinophilia severity were examined. All the cases were reviewed according to the old and new diagnostic criteria for EGPA.
Results: Among the 1567 patients with pulmonary symptoms and peripheral eosinophilia, pulmonary infection was the most common cause, followed by asthma and COPD. Mild eosinophilia was detected in the majority of the patients (90.5%). The highest mean eosinophil counts were observed in malignancies, hematological diseases and rheumatological diseases (including EGPA), respectively. Eosinophilia severities had significant difference between the diagnostic subgroups (p<0.001). The data were revised for EGPA with old and current diagnostic criteria. The false positivity rate of the old criteria was found to be significantly higher than the correctly applied current criteria (92.8% and 33.3%). Proper application of the current classification criteria regarding EGPA, which is among the causes of severe eosinophilia, will prevent unnecessary tests in this regard.
References
Nakajima T, Yamada H, Iikura M, et al. Intracellular localization and release of eotaxin from normal eosinophils. FEBS Lett. 1998;434(3):226-30. doi: 10.1016/s0014-5793(98)00863-1
Bhatt SP, Rabe KF, Hanania NA,et al; BOREAS Investigators. Dupilumab for COPD with Type 2 Inflammation Indicated by Eosinophil Counts. N Engl J Med. 2023; 389(3):205-14. doi: 10.1056/NEJMoa2303951
Nopsopon T, Lassiter G, Chen ML, et al. Comparative efficacy of tezepelumab to mepolizumab, benralizumab, and dupilumab in eosinophilic asthma: A Bayesian network meta-analysis. J Allergy Clin Immunol. 2023;151(3):747-55. doi: 10.1016/j.jaci.2022.11.021
Öcal N, Doğan D, Çiçek AF, Yücel O, Tozkoparan E. Acute Eosinophilic Pneumonia with Respiratory Failure Induced by Synthetic Cannabinoid Inhalation. Balkan Med J. 2016;33(6):688-90. doi: 10.5152/balkanmedj.2016.151145
Shah P, Sah R, Pradhan S, et al. Pulmonary Paragonimiasis: A Case Series. JNMA J Nepal Med Assoc. 2023;61(259):290-3. doi: 10.31729/jnma.8080
Cottin V. Eosinophilic Lung Diseases. Immunol Allergy Clin North Am. 2023;43(2):289-322. doi: 10.1016/j.iac.2023.01.002
Wu C, Li Z, Wang C, Deng Z. Clinical characteristics, management, and outcome of eosinophilic pneumonia associated with daptomycin. Med Clin (Barc). 2023;160(1):17-22. doi: 10.1016/j.medcli.2022.03.017
Masi AT, Hunder GG, Lie JT, et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum. 1990;33(8):1094-100. doi: 10.1002/art.1780330806
Grayson PC, Ponte C, Suppiah R, et al. DCVAS Study Group. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis. Ann Rheum Dis. 2022;81(3):309-14. doi: 10.1136/annrheumdis-2021-221794
Kiani A, Rahimi F, Afaghi S, et al. Association of Upon-Diagnosis Blood Eosinophilic Count with Frequency and Severity of Annual Exacerbation in Chronic Obstructive Pulmonary Disease: A Prospective Longitudinal Analysis. Can Respir J. 2023;2023:8678702. doi: 10.1155/2023/8678702
Naureen S, Hart S, Jawad N, Kennan N, Faruqi S. Long term nitrofurantoin induced interstitial lung disease: a case series and literature review. Sarcoidosis Vasc Diffuse Lung Dis. 2023;40(4):e2023050. doi: 10.36141/svdld.v40i4.13827
Okada R, Nakachi S, Inokuma S. The severity of peripheral blood eosinophilia indicates an eosinophilia-associated disease corresponding to its level. Allergol Int. 2016;65:112-4. doi: 10.1016/j.alit.2015.07.006
Fijolek J, Wiatr E, Piotrowska-Kownacka D, Roszkowski-Sliz K. The role of peripheral eosinophilia in diagnosing lung disorders: experience from a single pneumonological center. Multidiscip Respir Med. 2021;16(1):770. doi: 10.4081/mrm.2021.770
Sade K, Mysels A, Levo Y, Kivity S. Eosinophilia: a study of 100 hospitalized patients. Eur J Intern Med. 2007;18:196-201. doi: 10.1016/j.ejim.2006.09.031
Lombardi C, Passalacqua G. Eosinophilia and diseases: clinical revision of 1862 cases. Arch Intern Med. 2003;163:1371-3. doi: 10.1001/archinte.163.11.1371-b
Klion AD, Law MA, Riemenschneider W, et al. Familial eosinophilia: a benign disorder? Blood. 2004;103:4050-5. doi: 10.1182/blood-2003-11-3850
Bjerrum OW, Siersma V, Hasselbalch HC, Lind B. Association of the blood eosinophil count with end-organ symptoms. Ann Med Surg. 2019;45:11-8. doi: 10.1016/j.amsu.2019.06.015
Harrold LR, Andrade SE, Go AS, et al. Incidence of Churg-Strauss syndrome in asthma drug users: a population-based perspective. J Rheumatol. 2005;32:1076-80.
Cottin V, Bel E, Bottero P, et al. Revisiting the systemic vasculitis in eosinophilic granulomatosis with polyangiitis (Churg-Strauss): A study of 157 patients by the Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires and the European Respiratory Society Taskforce on eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Autoimmun Rev. 2017;16(1):1-9. doi: 10.1016/j.autrev.2016.09.018
Fijolek J, Radzikowska E. Eosinophilic granulomatosis with polyangiitis - Advances in pathogenesis, diagnosis, and treatment. Front Med (Lausanne). 2023;10:1145257. doi: 10.3389/fmed.2023.1145257
Villeneuve T, Prévot G, Pugnet G, et al. Role of bronchoscopy for respiratory involvement in granulomatosis with polyangiitis and microscopic polyangiitis. ERJ Open Res. 2023 ;9(5):00141-2023.
Han Q, Chen X, Xu X, et al. The Application of Transbronchial Lung Cryobiopsy and Uniportal and Tubeless Video-Assisted Thoracic Surgery in the Multidisciplinary Diagnosis of Interstitial Lung disease-A Real-World Prospective Study. Front Mol Biosci. 2021;8:681669. doi: 10.1183/23120541.00141-2023
Schnabel A, Holl-Ulrich K, Dalhoff K, et al. Efficacy of transbronchial biopsy in pulmonary vaculitides. Eur Respir J. 1997;10:2738-43. doi: 10.1183/09031936.97.10122738
Tertemiz KC, Alpaydın AÖ, Güler N, Karaçam V, Gürel D, Gezer NS. Transbronchial lung cr onchial lung cryobiopsy for the diagnosis of diffuse obiopsy for the diagnosis of diffuse parenchymal lung disease: Pitfalls and challenges, a single center experience. Turk J Med Sci. 2023;53(1):100-8. doi: 10.55730/1300-0144.5563
Kania A, Misiaszek M, Vašáková M, et al. Cryobiopsy in the diagnosis of idiopathic pulmonary hemosiderosis: a case report. J Thorac Dis. 2019;11(7):3195-201. doi: 10.21037/jtd.2019.07.17
Troy LK, Grainge C, Corte TJ, et al.; Cryobiopsy versus Open Lung Biopsy in the Diagnosis ofInterstitial lung Disease Alliance (COLDICE) Investigators. Diagnosticaccuracy of transbronchial lung cryobiopsy for interstitial lung diseasediagnosis (COLDICE): a prospective, comparative study. Lancet Respir Med. 2020;8:171-81. doi: 10.1136/bmjresp-2019-000443
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