Dr Rajesh Swarnakar MD,DTCD,DNB,FCCP(USA) Consultant Pulmonologist &Director

1. Raised Eosinophill Count : Clinical Significance Dr Rajesh Swarnakar MD,DTCD,DNB,FCCP(USA) Consultant Pulmonologist &Director Getwell Hospital & Research Institute, NAGPUR

2. -Two-lobed, polymorphonuclear leukocyte 12 to 15 um diameter- Created by IL-3, Il-5 and GM-CSF -Three granule types, largest made up of MBP (major basic protein)- Kills Parasites, tumor cells, -Circulates <18 hours- 100-400 x more in tissues than in blood Eosinophil – our friend or foe ?

3. Can happen in Blood&Tissue Raised Eosinophill Count: • Bronchoscopy(BAL) EOS Percentage (%) rather than absolute number Normal volunteers = < 1% • Blood Eosinophillia : Sampling peripheral blood • Pulmonary Eosinophillia:Measured in BAL Eosinophils count: What’s Normal? • Blood EOS (#) = up to 600/cmm

4. Eosinophil – associated diseases and disorders

5. The degree of Blood eosinophilia can be categorized into : Mild 500 to 1500 cells/microL Moderate 1500 to 5000 cells/microL Severe >5000 cells/microL Categories of Eosinophilia Peripheral eosinophilia can be divided into categories of , or idiopathic eosinophilia primary, secondary,

6. Primary eosinophilia Usually occurs in the context of hematologic malignancies, such as acute leukemias or chronic myeloid disorders, when there is evidence of clonal expansion of eosinophils Eosinophils can also be seen in Hodgkin's and non Hodgkin lymphoma and other metastatic cancers, but the associated eosinophils are not of a clonal nature in this situation The most common cause for secondary eosinophilia : is parasitic lung infection. Noninfectious causes of secondary eosinophilia include allergic disorders, medications, toxins, autoimmune diseases, and endocrine disorders such as Addison's disease.

7. A diagnosis of idiopathic eosinophilia is considered when a thorough evaluation does not identify either a primary or secondary cause of eosinophilia

8. Diseases Associated with Blood & Pulmonary Eosinophilia • Pulmonary Eosinophilic Syndromes of Known Cause: Parasitic-induced eosinophilic pneumonias (including Loeffler’s syndrome) Drug-or toxin-induced eosinophilic pneumonias Tropical pulmonary eosinophilia Allergic bronchopulmonary mycosis. • Pulmonary Eosinophilic Syndromes of Unknown Cause: Idiopathic acute eosinophilic pneumonia Chronic eosinophilic pneumonia Churg-Strauss syndrome (allergic granulomatosis and angiitis) Idiopathic hypereosinophilic syndrome

9. Other Lung Diseases Variably Associated with Eosinophilia:Asthma/allergy Bronchocentric granulomatosis Bronchiolitis obliterans-organizing pneumonia Infections – Fungal (esp.Coccidioidomycosis, Aspergillus,Pneumocystis jirovecii) -Tuberculosis Interstitial lung disease -Idiopathic pulmonary fibrosis -Collagen-vascular disease associated -Sarcoidosis -Eosinophilic granuloma (pulmonary histiocytosis X) Malignancy -Non–small-cell cancer of lung -Non-Hodgkin’s lymphoma -Myeloblastic leukemia Miscellaneous (e.g., lung transplantation, ulcerative colitis Treatment of primary disease suffices to bring down raised eosinophil count.

11. Algorithmic approach to evaluation patients with pulmonary/blood eosinophillia : • ( Am J Respir Crit Care Med 150:1423-138,1994.)

12. CollagenVascular Disease HIV Risks Drugs Asthma History Travel History History & Physical Exam Strongyloides Ascaris Schistosoma Ancylosioma Stool Ova & Parasite Exam Pulmonary Function Tests Restriction Obstruction Non- Pulmonary Organ Involvement Pulmonary Involvement Only Churg-Strauss Chest x-ray Normal IgE < 1.000 Chest x-ray Abnormal IgE > 2.000 Pneumocystis Strongyloides Aspergillus Cryptococcus BronchoalveolarLavage Asthma > 20% Eosinophils < 20% Eosinophils Allergic Bronchopulmonary Aspergillosis Bronchocentric Granulomatosis Blood Eosinophil Count Interstitial Lung Disease Drug Reaction High Moderate Low/Normal Hypereosinophilic Syndrome Acute Eosinophilic Pneumonia Chronic Eosinophilic Pneumonia Simple Pulmonary Eosinophilia

15. Thank you for your Kind attention This presentation is available on www.lungscare.com/ppt Email : drrajeshswarnakar@gmail.com

16. ICONIC - 2014 International Conference on Insights and Management of COPD 1st -2nd February, 2014 Hotel Hyatt Regency, Pune, India Dear friends and colleagues, On behalf of the organising committee, it gives us immense pleasure to welcome you to the first international conference on COPD – ICONIC 2014, to be held on 1st and 2nd February, 2014 at “Hotel Hyatt Regency”, Pune. The scientific programme will cover insights on the burden, pathophysiology, risk factors for COPD, advances in disease management and new directions for research in COPD, and a discussion on the much needed policy change in the management of COPD practices in India. Come listen to some of the internationally acclaimed leaders in Respiratory Medicine from across the globe including Prof. P. J. Barnes, Prof. James Hogg, Dr. John Walsh, Dr. Robert A. Wise, Dr. Sonia Buist, Dr. John R. Balmes and others. Once again we extend a cordial welcome to you all and look forward to your active participation in ICONIC – 2014!!! ICONIC is Endorsed by: Organized by: Chest Research Foundation, India and Johns Hopkins University, USA Organizing committee office: Chest Research Foundation, Kalyani Nagar, Pune 411014, INDIA Secretariat contact: Telephone (Contact): +91 22 2494 0518  Fax: +91 22 2494 0517  Email: secretariat@iconic2014.com Website: : www.iconic2014.com