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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 132-135

Correlation of high-sensitivity C-reactive protein with severity and spirometric values of asthma


1 Department of Microbiology, College of Medicine, University of Kufa, Kufa, Iraq
2 Medical Lab., Alsader Teaching Hospital, Najaf, Iraq

Date of Submission17-Jan-2020
Date of Decision20-Feb-2020
Date of Acceptance14-Mar-2020
Date of Web Publication15-Jul-2020

Correspondence Address:
Dr. Falah Abdulhasan Deli
College of Medicine, University of Kufa, PO Box 156, Kufa, Najaf 31001
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJIM.AJIM_5_20

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  Abstract 


Background: Asthma is an important community problem that increased in incidence worldwide, with a considerable acute and chronic sequale and being an inflammatory process, following and interrupting this process is extremely important. High-sensitivity C-reactive protein (hs-CRP) is proposed to be a good indicator for the degree of inflammation; we aimed to utilize hs-CRP as an inflammatory biomarker to assess the severity and stability of asthma. Patients and Methods: Forty-one asthmatics (19 males and 24 females) with a mean age of 41 ± 14 and 22 years and gender- and body mass index-matched controls were assessed by questionnaire, spirometry, and level of hs-CRP in Al-Sader Teaching Hospital in Al-Najaf at 2018. Results: The mean values of hs-CRP were significantly higher in asthma than the control group, and this was marked in asthmatics during acute exacerbation than those with stable clinical status, hs-CRP was recorded significantly higher in adult asthmatic patients as compared to adolescents and middle aged, smoking history and allergic history did not show any significant difference, and the elevation of hs-CRP was markedly more in acute exacerbation as compared to stable state; on the other hand, the level of hs-CRP was correlated significantly more with the drop in forced expiratory volume1 and peak expiratory flow rate, indicating the relation with the severity of the illness. Conclusions: Hs-CRP can be considered as a good biomarker for assessing the severity and stability of asthma.

Keywords: Asthma, forced expiratory volume1, high-sensitivity C-reactive protein, peak expiratory flow rate, spirometry


How to cite this article:
Rasheed SM, Al-Ghizzi IJ, Deli FA, Aljazaaeri T. Correlation of high-sensitivity C-reactive protein with severity and spirometric values of asthma. APIK J Int Med 2020;8:132-5

How to cite this URL:
Rasheed SM, Al-Ghizzi IJ, Deli FA, Aljazaaeri T. Correlation of high-sensitivity C-reactive protein with severity and spirometric values of asthma. APIK J Int Med [serial online] 2020 [cited 2020 Aug 10];8:132-5. Available from: http://www.ajim.in/text.asp?2020/8/3/132/289797




  Introduction Top


C-reactive protein (CRP) is a β-globulin increased in production in acute illness contributing to the activation of complement system; it is termed C because it causes precipitation of fraction C of extract of pneumococci.,[1] such as erythrocyte sedimentation rate (ESR), CRP increased in many inflammatory and infectious problem, and it is nonspecific but a sensitive test for acute illness; moreover, the fluctuation of CRP level is more rapidly changeable with the change of clinical status as compared to slow change in ESR; consequently, monitoring the activity of disease process will be more valuable.[2],[3],[4]

Trivial increase in CRP can be detected by techniques that determine high-sensitivity CRP test (hs-CRP); the emergence of these techniques had led to the increase in the use of hs-CRP in many acute and acute on chronic illness including inflammatory, infectious, degenerative, endocrine, metabolic, and even neuropsychiatric problems, and there are diverse studies on the importance of hs-CRP in the assessment of severity and outcome of illness such as acute myocardial infarction and dementia.[3],[5],[6],[7],[8],[9],[10]

There are continued and considerable concerns for the application of hs-CRP assessment in asthma, and multiple studies focused on the relation of asthma severity as assessed by symptoms questionnaire and spirometric values with the levels of hs-CRP in adult and pediatric age groups.[11],[12]

Asthma is considered for the past four decades as a chronic inflammatory condition associated with acute exacerbation.[13]

During these four decades, asthma is getting more prevalent because of many factors including atmospheric changes, life style, and food modification and to great extent to improved ways of diagnosis; in the United States, more than 8% of children were found to be asthmatics in 2016 possibly doubling the incidence during the 60s of the 20th century.[14]

Being chronic inflammatory disease, morbidity, and to some extent, mortality were not limited to acute exacerbations but to chronic residual changes marked by the remodeling process and the irreversible bronchial and pulmonary changes, collectively for these reasons studying and assessment of the inflammatory markers is of crucial importance and hs-CRP determination may be a practical way in this aspect.[10],[11],[12],[14]

Aim of the study

The aim of the study was to utilize hs-CRP as an inflammatory biomarker to assess the severity and stability of asthma.


  Patients and Methods Top


This study was performed at Al-Sader Teaching Hospital in Al Najaf city during the period from March to August 2018, 41 patients diagnosed as asthmatics were included, 19 were males and 24 females, with a mean age of 41.1 ± 13.7.

The diagnosis of asthma was based on relevant medical history and physical examination, and in patients with significant smoking history, asthma was confirmed after obtaining more than 15% improvement of airway obstruction 20 min after administration of 2 puffs of metered dose salbutamol inhalation or a half milliliter of salbutamol solution diluted in 3 ml of isotonic saline and given through electrical nebulizer.

The patients with the following situations were excluded from the study: those with acute respiratory infection, those with a clinical suggestion of chronic obstructive pulmonary disease and a history of pulmonary tuberculosis, patients with features suggestive of bronchiectasis, any patient with other chronic nonrespiratory condition including cardiac failure, renal, and liver problem, and patients with connective tissue diseases.

Twenty-two age-, gender-, and body mass index (BMI)-matched persons were taken as a control group, 9 males and 13 females with a mean age of 39.6 ± 12.2 years.

Full history and physical examination was done for patients and control groups, asthma severity assessed according to GINA (Global Initiative of Asthma) classification into three grades:

Mild asthma

It was well controlled with short-acting bronchododilator alone or with low-dose inhaled corticosteroids (ICSs) or leukotriene antagonists.

Moderate asthma

It was well controlled with low-dose ICS/long-acting beta 2-agonists (LABA).

Severe asthma

It needed high-dose ICS/LABA to improve the symptomatology or failure of these measures.[15]

Spirometric assessment was done for both the groups using Spirolab 111, MIR, the test was done by a competent and well-trained respiratory practitioner, and the best readings of forced expiratory volume (FEV1) and peak expiratory flow rate (PEFR) were taken, and 3 ml of blood was withdrawn for the assessment of hs-CRP where the serum was separated and utilized hs-CRP detection kit (nephelometry) by Genrui Biotech. Inc., and according to the protocols, the reference range for the normal values was 10 mg/L (www.genrui.bio.com).

The study was ethically approved by the Medical Ethics Committee of the Faculty of Medicine/University of Kufa No. 892 at January 20, 2018; written informed consents were obtained from all participants.

Statistical analysis

Statistical analysis was done using the Statistical Package for the Social Sciences version 22, IBM, 2014. Statistical analysis was performed using t-test, Chi-square tests, and Persons correlation®. P value set at ≤ 0.05 is considered as a statistically significant difference.


  Results Top


According to demographic characteristics of the study population, there were no significant changes between the patients and control groups with regard to age, gender, smoking, and BMI; on the other hand, a history of other allergic problem in the same patient and or in other family member was observed significantly higher in asthma group, and expectedly, FEV1 and PEFR were significantly lower in asthma patients as compared to the control group [Table 1].
Table 1: Demographic and clinical characteristics of the studied groups

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The mean values of hs-CRP was significantly higher in asthma (whether in stable or in acute exacerbation) than the control group [Table 2] and [Table 3], the elevation of hs-CRP was more marked in those asthmatic patients assessed during acute exacerbation than those with stable clinical status [Table 2].
Table 2: High-sensitivity C-reactive protein of the patient and control groups

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Table 3: Distribution of raised high-sensitivity C-reactive protein in the studied patients and control groups

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In this study, hs-CRP was recorded significantly higher in adult asthmatic patients as compared to adolescents and middle aged; on the other hand, the gender, smoking history, and allergic history did not show any significant difference, while patients with acute exacerbation had more elevated hs-CRP [Table 4].
Table 4: Association between some host and clinical characteristics and high levels of high-sensitivity C-reactive protein in asthmatic patients

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Finally, biochemical levels were correlated significantly more with the drop in FEV1 and PEFR, indicating the relationship with the severity of the illness [Figure 1] and [Figure 2].
Figure 1: High-sensitivity C-reactive protein titer according to the forced expiratory volume1 of the asthmatic patients. FEV1: Forced expiratory volume in the first second. Hs-CRP: High-sensitivity C-reactive protein

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Figure 2: High-sensitivity C-reactive protein titer according to the peak expiratory flow rate of the asthmatic patients. PEFR: Peak expiratory flow rate, Hs-CRP: High-sensitivity C-reactive protein

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  Discussion Top


Asthma is a common respiratory problem, inflammation is marked by inflammatory cells infiltration and release of different inflammatory biomarkers surging in acute exacerbations (acute asthmatic episodes) and continuing in a considerable degree in chronic state leading to chronic sequelae where irreversible changes termed as airways remodeling can occur, these can be halted to a great degree by proper control of asthma applying medications specially inhaled steroids.[13]

For a long time, hs-CRP is considered a good biomarker for inflammatory conditions, acute, chronic, and acute on chronic conditions and it gained a large concerns with regard to inflammatory status of asthma, although many researchers found a weak association between the clinical and physiological assessment and the changes in hs-CRP.[14]

Most of the researches did found the opposite, Shimoda et al.[12] found a strong association between the concentration of hs-CRP and the increased inflammatory cells in sputum of asthmatic patients whether eosinophils or neutrophils; same wise, Sahoo et al. found high serum concentration of hs-CRP in atopic asthmatics and the increament of hs-CRP was correlated with increasing age, while no such changes were observed in nonatopic asthmatic pointing to the significant atopic inflammatory changes.[15],[16],[17]

Other investigators support the positive correlation of the level of hs-CRP and the disease activity that was assessed by different methods including symptoms questionnaires and spirometric assessment;[18],[19],[20],[21],[22] in this study, not only the positivity of hs-CRP was higher in asthmatic as compared to the healthy control but also the serum level was significantly higher, and moreover, even those asthmatic during a stable state were found to have higher results as compared to the control group though the levels of hs-CRP were markedly more in patients during exacerbation; these findings, which are consistent with most of other investigators, strongly stress the importance of better and continuous control of airway obstruction by any means possible, primarily medications to decrease the likelihood of development of irreversible changes[17],[18],[21],[23] and to more extent some try to consider assessment of hs-CRP as a marker for better grading of asthma.[23] Gender has no effect on the level of CRP and this is in agreement with most studies, but in this study, there was no effect of smoking, a surprising and unexplainable finding that is not observed in most studies,[17] and the small sample may have an effect on this result.


  Conclusions Top


Hs-CRP can be considered as a good biomarker for judging the severity and stability of asthma, and future studies for the impact on the long-term outcome may be fruitful in minimizing the unwanted and irreversible changes of asthma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Mizumori Y, Katayama S, Igishi T, Mochiduki Y, Nakahara Y, Kawamura T, et al. High-sensitivity C-reactive protein and changes over time in forced expiratory volume in 1 second in adult-onset asthma. Journal Jpn Respir Soc 2010; 48:719-23.  Back to cited text no. 21
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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