EFFECT OF GLUCOCORTICOIDS ON HUMORAL AND CELLULAR-IMMUNITY AND ON AIRWAY INFLAMMATION IN PATIENTS WITH STEROID-DEPENDENT INTRACTABLE ASTHMA

The effects of glucocorticoids on the proportion of lymphocytes in bro nchoalveolar lavage (BAL) fluid in relation to humoral and cellular im munity were studied in 56 patients with steroid-dependent intractable asthma. To analyze the mechanism responsible for reduced numbers of BA L lymphocytes, we divided the subjects into 4 groups according to thei r BAL lymphocyte proportions: 0-4.9%, 5.0-9.9%, 10.0-14.9%, and 15.0-2 0.0%. Serum IgG levels and the peripheral lymphocyte count were signif icantly reduced in patients with a low proportion of BAL lymphocytes ( less than 9.9%) than in those with more than 10% BAL lymphocytes. Dela yed cutaneous reactivity to purified protein derivative was suppressed in patients with a low proportion of BAL lymphocytes (less than 4.9%) . The mean proportion of BAL neutrophils tended to increase as the pro portion of BAL lymphocytes decreased. These results show that the redu ction in BAL lymphocytes produced by glucocorticoids is associated wit h suppressed humoral and cellular immunity, and that under such condit ions the proportion of BAL neutrophils increases.