Chest
Volume 103, Issue 5, May 1993, Pages 1482-1488
Journal home page for Chest

Clinical Investigations
The Bronchitis Index: A Semiquantitative Visual Scale for the Assessment of Airways Inflammation

https://doi.org/10.1378/chest.103.5.1482Get rights and content

Flexible fiberoptic bronchoscopy has been proven to be an effective tool for the assessment and characterization of airway inflammation. Visual inspection of airways affected by chronic bronchitis discloses an abnormal appearance characterized by erythema, edema, secretions, and friability. It was hypothesized that the visual appearance of airway inflammation could be assessed in a semiquantitative manner. A bronchitis index (BI) was developed that scores the visual appearance of airways according to the presence or absence of abnormal edema, erythema, secretions, and friability (0=normal, 3 = remarkably abnormal). The BI was determined in three study groups: 86 subjects with chronic bronchitis, 15 subjects who smoked cigarettes, but did not have chronic bronchitis, and 25 normal, nonsmoking control subjects. The reproducibility of the BI was determined by comparing the results from pairs of two independent observers assessing 249 subjects undergoing fiberoptic bronchoscopy under various investigative protocols. In total, nine investigators scored the airways. For the three observer pairs with more than six observations, there were no differences noted in the BI (p=0.43, 0.67, 0.82). To control for the effect of cough upon the BI, lidocaine usage was recorded. No correlation was found between lidocaine usage and BI. As previously noted for a smaller group of subjects, the BI was found to be elevated in those with chronic bronchitis (13.2 ±0.53) compared with both asymptomatic smokers (8.5 ±0.89, p<0.0005) and normal volunteers (2.3 ±0.55, p<0.0001); the latter two groups also differed significantly (p<0.0001). The BI was also found to correlate significantly with bronchial sample lavage fluid neutrophil content in lavage fluid obtained after determination of the BI and with cigarette smoking as quantitated by pack years. Conversely, the BI correlated negatively with the spirometric measures of airway obstruction, FEV“ FEV1/FVC, FEV25-75, and FEFmax. Thus, the BI appears to be a reproducible, semiquantitative assessment of the visual appearance of airway inflammation. It may be a useful bronchoscopic adjunct for the assessment of airway inflammation in clinical investigations.

Section snippets

METHODS

The utility of the BI was investigated in three study groups: 86 subjects with a history of cigarette smoking, chronic bronchitis, and airflow obstruction, 15 subjects with a history of cigarette smoking, but without cough or sputum production (asymptomatic smokers), and 25 normal, nonsmoking volunteers. Subjects were included in the chronic bronchitis group if they met the following criteria: (1) cough and sputum production on most days of the month for at least three months a year during the

RESULTS

Because subjects were assigned to groups based on entry criteria that did not include age, several significant differences were noted among the subject groups. Subjects with chronic bronchitis were older (51.2 ± 1.2 years) than asymptomatic smokers (33.2 ±1.7 years) and normal volunteers (33.1 ± 2.1 years) (p<0.01, both groups), while no difference was found between the normal volunteers and asymptomatic smokers. The asymptomatic smokers had smoked less (36.3 ±3.9 pack-years) than the patients

DISCUSSION

Airways inflammation is thought to play a prominent role in the pathogenesis of chronic bronchitis.2, 3, 4, 8 Bronchoalveolar lavage and quantitation of lavage fluid proteins and cells have been used to assess airway inflammation.5, 8, 13 The BI was formulated to provide another bronchoscopic parameter of inflammation. Visual inspection of the airways is limited to larger airways and these may not reflect changes in more peripheral airways. However, the findings that the BI was elevated more in

ACKNOWLEDGMENTS

The authors would like to acknowledge the expert advice of Dr. James Anderson concerning the data analysis and the secretarial assistance of Jeanette Danielsen.

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Manuscript received June 22; revision accepted September 15

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