Cellular characteristics of sputum from patients with asthma and chronic bronchitis.

Gibson, Peter G.; Girgis-Gabardo, Adele; Morris, Marilyn M.; Mattoli, Sabrina; Kày, J. M.; Dolovich, J.; Denburg, Judah A.; Fe, Hargreave

doi:10.1136/thx.44.9.693

Cited by 212 publications

(146 citation statements)

References 18 publications

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“…Recent studies have proposed the analysis of induced sputum as a reliable and noninvasive method to investigate airway inflammation in patients with asthma. 14,15,27,28 Similar to the findings from bronchial biopsies and bronchoalveolar lavage fluid examinations, the sputum of patients with asthma is characterized by an increase in proportion of eosinophils and the level of ECP. 29 Moreover, sputum examination has been demonstrated to be a more accurate diagnostic test than measurement of blood eosinophils or serum ECP in detecting airway eosinophilic inflammation, 29 suggesting a relevant role of sputum analysis in the identification and monitoring of airway inflammation in asthma.…”

Section: Discussionsupporting

confidence: 50%

Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: Results of a factor analysis

Rosi

Ronchi

Grazzini

et al. 1999

Journal of Allergy and Clinical Immunology

148

111

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Background: Recent studies have shown weak associations among FEV 1 , bronchial hyperresponsiveness (BHR), sputum eosinophils, and sputum eosinophil cationic protein (ECP), suggesting that they are nonoverlapping quantities. The statistical method of factor analysis enables reduction of many parameters that characterize the disease to a few independent factors, with each factor grouping associated parameters. Objective: The purpose of this study was to demonstrate, by using factor analysis, that reversible airway obstruction, BHR, and eosinophilic inflammation of the bronchial tree, as assessed by cytologic and biochemical analysis of sputum, may be considered separate dimensions that characterize chronic bronchial asthma. Methods: Ninety-nine clinically stable patients with a previous diagnosis of asthma underwent spirometry, sputum induction, and histamine inhalation tests. Results: Most patients were nonobstructed (FEV 1 , 91% ± 20%); a low level of bronchial reversibility (FEV 1 increase after β 2 -agonist, 7.8% ± 9.2%) and BHR (histamine PC 20 FEV 1 geometric mean, 0.98 mg/mL) were found. Sputum eosinophil differential count (12.4% ± 17.7%) and sputum ECP (1305 ± 3072 µg/mL) were in the normal range of our laboratory in 38 and 22 patients, respectively. Factor analysis selected 3 different factors, explaining 74.8% of variability. Measurements of airway function and age loaded on factor I, PC 20 FEV 1 and β 2 -response loaded on factor II, and sputum ECP and eosinophils loaded on factor III. Additional post hoc factor analyses provided similar results when the sample was divided into 2 subgroups by randomization, presence of airway obstruction, degree of BHR, percentage of sputum eosinophils, or concentration of sputum ECP. Conclusions: We conclude that airway function, baseline BHR, and airway inflammation may be considered separate dimensions in the description of chronic asthma. Such evidence supports the utility of routine measurement of all these dimensions. (J Allergy Clin Immunol 1999;103:232-7.)

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Section: Discussionsupporting

confidence: 50%

Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: Results of a factor analysis

Rosi

Ronchi

Grazzini

et al. 1999

Journal of Allergy and Clinical Immunology

148

111

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“…Mast cells were found in only four of the 42 asthmatic children. This contrasts with adult asthma where mast cells are frequently seen [5,26]. Possible explanations are that the mast cells were present in the airway but degranulated, or restricted to the airway wall only.…”

Section: Discussionmentioning

confidence: 43%

Persistence of sputum eosinophilia in children with controlled asthma when compared with healthy children

Cai¹,

Carty²,

Rl³

et al. 1998

Eur Respir J

121

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We aimed to describe induced sputum cell counts in healthy nonasthmatic children, and to compare these to children with controlled and uncontrolled asthma. Following clinical assessment and spirometry, ultrasonically nebulized hypertonic saline was used to induce sputum from children with asthma (n=50) and without asthma (n=72). Sputum was dispersed and cell counts performed to yield total and differential cell counts. Specific stains were used for eosinophil and mast cell counts. All of the children with asthma were receiving inhaled and/or oral corticosteroids. Current asthma control was assessed in terms of symptoms and lung function. Children were classified as controlled on inhaled corticosteroids (no current symptoms, normal lung function n=15), current symptomatic asthma (n=16) and asthma exacerbation (n=11). It was found that eosinophils comprised a median 0.3% (interquartile range (IQR): 0, 1.05) of cells in sputum from healthy children. Sputum eosinophils (4.3% (IQR: 15, 14.1) p=0.0005) and epithelial cells (14% (IQR: 6, 19.4) p=0.0005) were significantly higher in children with asthma than in nonasthmatic children. Children whose asthma was controlled, as well as those with symptoms, had more sputum eosinophils and epithelial cells than the nonasthmatics. Mast cells were found in the sputum of only four of the 42 children with asthma. This study demonstrates that eosinophilic airway inflammation and epithelial damage can occur in children with asthma. Airway inflammation persists even in those children who are receiving inhaled corticosteroids, have normal lung function and good symptomatic control of their disease.

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“…Examination of spontaneous or induced sputum promises to be a reliable direct method by which this can be achieved noninvasively [2][3][4][5][6][7][8].…”

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confidence: 99%

Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination

Pizzichini

Pizzichini²,

Efthimiadis³

et al. 1996

Eur Respir J

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265

212

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Sputum examination is being used increasingly as a noninvasive method to assess airway inflammation. Expectorated sputum has variable contamination with saliva. Methods of processing have included the selection of portions of the sample considered to be representative of pulmonary origin versus use of the whole specimen, which is confounded by varying volumes of saliva. We compared cell profiles and eosinophilic cationic protein (ECP) concentration in sputum selected from the expectorate and in the usually discarded residual portion to determine to what degree salivary contamination is minimized and if the results are representative of lower respiratory secretions. Sputum was induced with hypertonic saline in six healthy and nine asthmatic subjects. All portions considered to be of pure lower respiratory tract origin were selected from the residual. The selected and residual portions were treated with dithiothreitol, total cell counts and cell viability were obtained, cytospins were made for differential cell counts and supernatant was collected for ECP assay. Selected portions of the specimens, in comparison with the residual portion showed: little squamous cell contamination (median 1.2 vs 70%; p < 0.001); higher total cell counts.mL-1 (5.1 vs 0.5 x 10(6) cells.mL-1; p < 0.001); higher number of viable nonsquamous cells per sample (1.9 vs 0.6 x 10(6) cells; p < 0.001); higher slide quality score (7 vs 4; p < 0.001); and higher levels of ECP (768 vs 136 micrograms.L-1; p < 0.001). There were no differences in the differential cell counts of eosinophils (1.3 vs 3.8%), neutrophils (44 vs 32%), and lymphocytes (0.6 vs 0.6%). While the proportion of macrophages was lower (36 vs 54%; p < 0.05), the absolute number (41 vs 19 x 10(4) cells; p < 0.05) was higher in the selected portion. In summary, selection of all portions of induced sputum from the expectorate minimized the confounding influence of saliva. Loss of nonsquamous cells in the residual portion was variable but usually less than one third of those in the selected portion. With one exception, this loss had little influence on the differential counts of inflammatory cells. Similar observations apply to eosinophilic cationic protein levels. We conclude that, in healthy subjects and treated asthmatics, inflammatory markers in the selected portion of the expectorate can be used to represent those in the lower respiratory tract in general.

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Cellular characteristics of sputum from patients with asthma and chronic bronchitis.

Cited by 212 publications

References 18 publications

Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: Results of a factor analysis

Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: Results of a factor analysis

Persistence of sputum eosinophilia in children with controlled asthma when compared with healthy children

Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination

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