Relationship between pulmonary function tests, sputum eosinophilia and total serum IgE levels among asthmatic patients in Duhok, Iraq


  • Hamdia Yousif Issa Department of Biology, College of Science, University of Zakho, Duhok, Iraq
  • Ali A. Ramadhan Department of Medicine, College of Medicine, University of Duhok, Duhok, Iraq
  • Abdulazeez S. Safo Department of Medicine, College of Medicine, University of Duhok, Duhok, Iraq
  • Omar A. M. Al Habib Department of Biology, College of Science, International University of Erbil, Erbil, Iraq



Asthma, Eosinophilia, IgE level, Sputum


Background: Bronchial asthma is a disease characterized by reversible airway obstruction, airway inflammation; and hyper-responsiveness. The prevalence of asthma is high, and both its prevalence and burden have increased over the last several decades. The study of inflammatory markers has implications for the appropriate management of this disease. Inflammatory markers has implications for the appropriate management of this disease. Objective of the study is to determine the correlation between asthma severity using pulmonary function tests with sputum eosinophilia and total serum IgE levels.

Methods: This case-control study was conducted from March 2017 to September 2018 in the respiratory unit of Azadi general teaching hospital. It included 42 asthmatic patients and 18 healthy subjects. They underwent pulmonary function tests and measurement of total serum IgE levels. Induced sputum was done for asthmatic patients.

Results: The age of asthmatic patients ranged from 16-70 years (mean 42±19 years). The asthmatic patient’s female: male ratio was 1.8. Mild asthma was the most common severity group (N=18, 43%) followed by moderate asthma (N=14, 33%) then severe asthma (N=10, 24%). Abnormal sputum eosinophilia (≥3%) was detected in 90% of severe asthma (N=9) compared to 36% in moderate asthma (N=5) and 5.6% in mild asthma (N=1). There was significant statistical association between asthma severity and sputum eosinophilia (p=0.00004). The association between asthma severity and total serum IgE levels was highly significant (p<0.0000) with levels of total serum IgE increasing as the severity of asthma increases.

Conclusions: Severe asthma is the least common severity group in this study. Both abnormal sputum eosinophilia and total serum IgE levels are associated with the severity of asthma.


Kumar RM, Pajanivel R, Koteeswaran G, Menon SK, Charles PM. Correlation of total serum immunoglobulin E level, sputum, and peripheral eosinophil count in assessing the clinical severity in bronchial asthma. Lung Ind: Offic Organ Ind Chest Soc. 2017 May;34(3):256-61.

Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004 May;59(5):469-78.

Morris MJ, Mosenifar Z. Emedicine: Asthma. Medscape Reference. Available at: Accessed December 2019.

Bateman E1, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Resp J. 2008 Jan 1;31(1):143-78.

Kraft M, Martin RJ, Wilson S, Djukanovic R, Holgate ST. Lymphocyte and eosinophil influx into alveolar tissue in nocturnal asthma. Am J Resp Criti Care Medi. 1999 Jan 1;159(1):228-34.

Wagener AH, de Nijs SB, Lutter R, Sousa AR, Weersink EJ, Bel EH, et al. External validation of blood eosinophils, FENO and serum periostin as surrogates for sputum eosinophils in asthma. Thorax. 2015 Feb 1;70(2):115-20.

Subrahmanyam RM, Chandrashekara Srikantaiah PK, Silvia CR, Thirunavukkarasu S, Devi K, Rao M, Kumar V. Can bronchial asthma be classified based on the immunological status?. Lung Ind: Offic Organ Ind Chest Soc. 2011 Apr;28(2):110.

Cianchetti S, Bacci E, Ruocco L, Bartoli ML, Ricci M, Pavia T, Dente FL, et al. Granulocyte markers in hypertonic and isotonic saline-induced sputum of asthmatic subjects. Eur Resp J. 2004 Dec 1;24(6):1018-24.

Beeh KM, Ksoll M, Buhl R. Elevation of total serum immunoglobulin E is associated with asthma in nonallergic individuals. Eur Respir J. 2000;16:609-14.

Fahy JV, Fleming HE, Wong HH, Liu JT, Su JQ, Reimann J, et al. The effect of an anti-IgE monoclonal antibody on the early-and late-phase responses to allergen inhalation in asthmatic subjects. Am J Resp Crit Care Medi. 1997 Jun;155(6):1828-34.

Spanevello A, Beghe B, Bianchi A, Migliori GB, Ambrosetti M, Neri M, et al. Comparison of two methods of processing induced sputum: selected versus entire sputum. Am J Resp Criti Care Medi. 1998 Feb 1;157(2):665-8.

Global strategy for asthma management and prevention: Global Initiative for Asthma (GINA). 2011. Available at: http://

Tanaka A, Jinno M, Hirai K, Miyata Y, Mizuma H, Yamaguchi M, et al. Longitudinal increase in total IgE levels in patients with adult asthma: an association with poor asthma control. Resp Res. 2014 Dec;15(1):144.

National AE, Prevention P. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Aller Clini Immunol. 2007 Nov;120(5 Suppl):S94.

Petronella SA, Conboy-Ellis K. Asthma epidemiology: risk factors, case finding, and the role of asthma coalitions. Nurs Clini North Am. 2003 Dec;38(4):725-35.

Holt PG, Sly PD. Interactions between RSV infection, asthma, and atopy: unraveling the complexities. J Experim Medi. 2002 Nov 18;196(10):1271-5.

Strachan DP, Cook DG. Parental smoking and childhood asthma: longitudinal and case-control studies. Thorax. 1998 Mar 1;53(3):204-12.

Duane L, Sherril, and Michael D. Longitudinal evaluation of the association between pulmonary function and total serum IgE. Am J Respir Crit Care Med 152:98-102, 1995.

Anupama N, Sharma MV, Nagaraja HS et al. The serum immunoglobulin E level reflects the severity of bronchial asthma. J Physiolog Sci. 2005;18(3);35-40.

Bapna A, Mathur US, Saigal R, Arya A. The Relationship Of Allergic Bronchial Asthma, Cutaneous Sensitivity Reaction And Serum Total IgE. Lung Ind. 1990 May 1;8(2):76.

Hjellvik V, Tverdal A, Furu K. Body mass index as predictor for asthma: a cohort study of 118,723 males and females. Eur Resp J. 2010 Jun 1;35(6):1235-42.

Rengganis I, Rambe DS, Rumende CM, Abdullah M. Total serum IgE levels among adults patients with intermittent and persistent allergic asthmas. Medi J Indones. 2018 Dec 31;27(4):279-83.

Larsson K, Ställberg B, Lisspers K, Telg G, Johansson G, Thuresson M, et al. Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR). Resp Res. 2018 Dec 1;19(1):12.

Geraldes L, Todo-Bom A, Loureiro C. Airways inflammation evaluation. Upper and lower airways. Rev Portug Pneumol. 2009;15(3):443-60.

Bandyopadhyay A, Roy PP, Saha K, Chakraborty S, Jash D, Saha D. Usefulness of induced sputum eosinophil count to assess severity and treatment outcome in asthma patients Lung Ind: Offic Organ Ind Chest Soc. 2013 Apr;30(2):117-23.

Duncan CJ, Lawrie A, Blaylock MG, Douglas JG, Walsh GM. Reduced eosinophil apoptosis in induced sputum correlates with asthma severity. Eur Resp J. 2003 Sep 1;22(3):484-90.

Lemière C, Ernst P, Olivenstein R, Yamauchi Y, Govindaraju K, Ludwig MS, Martin JG, Hamid Q. Airway inflammation assessed by invasive and noninvasive means in severe asthma: eosinophilic and noneosinophilic phenotypes. J Aller Clini Immunol. 2006 Nov 1;118(5):1033-9.

Gibson PG, Girgis-Gabardo A, Morris MM, Mattoli S, Kay JM, Dolovich J, Denburg J, Hargreave FE. Cellular characteristics of sputum from patients with asthma and chronic bronchitis. Thorax. 1989 Sep 1;44(9):693-9.

Palomino AL, Bussamra MH, Saraiva-Romanholo BM, Martins MA, Nunes Mdo P, Rodrigues JC. Induced sputum in children and adolescents with asthma: safety, clinical applicability and inflammatory cells aspects in stable patients and during exacerbation. J Pediatr. 2005;81(3):216-4.

Novelli F, Lenzini G, Latorre M, Seccia V, Bartoli ML, Malagrinò L, et al. Influence of obesity and nasal polyps on severe asthma. Eur Respir J. 2013;42(Suppl 57):P4177.

Green RH, Brightling CE, McKenna S, Hargadon B, Parker D, Bradding P, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002 Nov 30;360(9347):1715-21.

Sandeep T, Roopakala MS, Silvia CR, Chandrashekara S, Rao M. Evaluation of serum immunoglobulin E levels in bronchial asthma. Lung Ind: Offic Organ Ind Chest Soc. 2010 Jul;27(3):138.

El Gazzar AG, Essawy TS, Awaad AH, Mansour AI. Evaluation of serum vitamin D and IgE in patients with bronchial asthma. Egypt J Bronchol. 2016 May 1;10(2):113.

Davila I, Valero A, Entrenas LM, Valveny N, Herráez L. Relationship between serum total IgE and disease severity in patients with allergic asthma in Spain. J Investigat Allergol Clini Immunol. 2015;25(2):120-7.

Barnes PJ, Adcock IM. How do corticosteroids work in asthma? Ann Intern Medi. 2003 Sep 2;139(5_Part_1):359-70.




How to Cite

Issa, H. Y., Ramadhan, A. A., Safo, A. S., & Al Habib, O. A. M. (2020). Relationship between pulmonary function tests, sputum eosinophilia and total serum IgE levels among asthmatic patients in Duhok, Iraq. International Journal of Research in Medical Sciences, 8(6), 2033–2038.



Original Research Articles