Inhaled corticosteroids in COPD

The importance of presenting absolute cell numbers when counting cells in biological samples is illustrated by the potentially misleading interpretation of data in the paper by Marco Confalonieri and colleagues. The authors concluded that, in addition to reduced sputum neutrophilia, the number of sputum macrophages increased significantly following treatment with inhaled beclomethasone dipropionate in patients with COPD. However, the observed increase in the proportion of sputum macrophages from 19.6% before treatment to 35.8% following treatment is entirely attributable to the reduced number of sputum neutrophils. From the data presented in the paper, the absolute numbers of diVerent cells in the sputum can be calculated (table 1), revealing that the absolute sputum macrophage count was essentially unchanged following treatment. It is important that the absolute numbers of cells, and not simply their proportions, are presented when measuring diVerential cell counts in sputum or any other biological sample.