Sputum in severe exacerbations of asthma: kinetics of inflammatory indices after prednisone treatment.

Pizzichini, Márcia Margaret Menezes; Pizzichini, Emílio; Clelland, L.; Efthimiadis, A.; Mahony, J. B.; Dolovich, J.; Fe, Hargreave

doi:10.1164/ajrccm.155.5.9154849

Cited by 258 publications

(265 citation statements)

References 29 publications

Supporting

Mentioning

234

Contrasting

Unclassified

Order By: Relevance

“…However, this is unlikely for two reasons. The first is that sputum eosinophils is a sensitive indicator of airway inflammation which develops before clinical exacerbations of asthma [4]. The second is that from the two studies so far comparing sputum with biopsies, when sputum cell counts are normal, usually no eosinophils were found in the biopsies [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…There is good evidence that sputum eosinophilia is associated with inflammatory and clinical improvement with corticosteroid treatment [4]. There is increasing evidence that corticosteroid treatment is not effective in the absence of sputum eosinophilia [31±33].…”

Section: Discussionmentioning

confidence: 99%

“…The inflammation is characteristically eosinophilic [3] and responds to corticosteroid treatment [4,5]. However, the symptoms of asthma are not specific, many patients appreciate variable airflow limitation poorly [6] and these features do not necessarily correlate with airway eosinophilia [7].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Parameswaran

Pizzichini

et al. 2000

Eur Respir J

View full text Add to dashboard Cite

The inflammatory component of asthma is usually assessed indirectly by symptoms and spirometry, these may be inaccurate. It can now be assessed directly and reliably by the examination of sputum cell counts. There is no information on how clinical assessment of the presence and type of airway inflammation compares with actual measurements.In this single-centre observational study, sputum was collected from 76 consecutive adults with asthma attending a tertiary chest clinic after their physicians had recorded the expected cell counts in sputum. The authors examined the extent of agreement between clinical judgement of sputum cell counts and actual counts in asthmatic patients (Cohen's Kappa) and the possible predictors of agreement (multiple logistic regression).Sixty-seven of the 76 sputum samples were suitable for analysis. Agreement between expected and actual cell counts occurred in 30/67 patients. The overall agreement for the different cell types was poor (estimated k=0.14, 95% confidence interval (CI)=0.02, 0.26). The experience of the physician in using sputum cell counts in clinical practice, steroid requirement at the time of assessment, and control of asthma as assessed by the physician or by the patient could not predict the chances of agreement or disagreement. Unaware of the sputum results, the physicians often changed treatment in a way that seemed inappropriate for the cell counts present.There is poor agreement between clinical judgement of the presence and type of airway inflammation in asthmatic patients and sputum cell counts. The impact of sputum examination on the outcomes of anti-inflammatory treatment now needs investigation. Eur Respir J 2000; 15: 486±490.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Parameswaran

Pizzichini

et al. 2000

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Sputum was induced by the method first described by PIZZICHINI et al [9]. Before induction, spirometry was performed, after which 200 mg of salbutamol was given by metered dose inhaler.…”

Section: Sputum Inductionmentioning

confidence: 99%

“…The aim of the present study was to evaluate the safety and success of sputum induction in patients with varying severity of COPD [9].…”

mentioning

confidence: 99%

Safety of sputum induction in chronic obstructive pulmonary disease

Rytilä¹,

Lindqvist²,

Laitinen³

2000

Eur Respir J

View full text Add to dashboard Cite

The aim of the present study was to evaluate the safety of sputum induction in patients with varying severity of chronic obstructive pulmonary disease.The subjects were 28 smokers with baseline forced expiratory volume in one second (FEV1) of (mean and range) 1.8 (0.8±2.9) L that is 53 (28±69)% of the predicted and reversibility of 2.5 (-7.4±9.9)%. Sputum was induced after premedication with 200 mg salbutamol at increasing concentrations (0.9, 3, 4, and 5%) of hypertonic saline nebulized by an ultrasonic nebulizer.The procedure was well tolerated, and none of the patients reported major sideeffects. However, the mean change from prebronchodilator FEV1 during induction was -8.5 (-23±11)%, p=0.001, and from postbronchodilator FEV1 -10.7 (-25±5)%, p<0.0001. Three (11%) of the patients had a fall in FEV1 from the prebronchodilator baseline of >20%, and a further 10 (36%) had a fall of 10±20%. Patients with greater reversibility in airway obstruction seemed to get the best benefit from the bronchodilator pretreatment, since there was an inverse relationship between reversibility in FEV1 and fall in FEV1 during induction (r= -0.4, p=0.03).It is concluded that sputum induction by hypertonic saline inhalation can cause meaningful bronchoconstriction in patients with chronic obstructive pulmonary disease, despite pretreatment with an inhaled b 2 -agonist. The results highlight the importance of monitoring spirometry during sputum induction to detect bronchoconstriction. Eur Respir J 2000; 15: 1116±1119. The study was supported by Astra Charnwood, UK and P. Rytila È was supported by a grant from the Ida Montin Foundation, Finland.Sputum induction by inhalation of hypertonic saline has been used as a direct and relatively noninvasive method to investigate airway inflammation. It has been applied in patients with asthma and chronic obstructive pulmonary disease (COPD) [1±4]. Sputum-induction methodology may offer important benefits in diagnosing patients with airflow obstruction and in comparing treatment strategies.Although no standardized method for the induction of sputum has been agreed upon, recently a consensus on the use of sputum induction in asthma has appeared [5]. The challenge procedure should be performed in a standardized manner, because hypertonic saline can cause asthmatics to suffer from airway constriction. This procedure includes spirometry before and during the induction as well as pretreatment with a short-acting b 2 -agonist.Some studies assess the safety of sputum induction in patients with asthma [6±8], but information on patients with COPD is scarce [3,4]. The aim of the present study was to evaluate the safety and success of sputum induction in patients with varying severity of COPD [9]. Materials and methods SubjectsThe authors studied 28 patients with at least a 2-yr clinical diagnosis of symptomatic COPD [10] and a smoking history of 20±103 pack-yrs (table 1). Two (7%) of them were exsmokers, all others were current smokers. Patients had to fulfil the following criteria: 1) prebronchod...

show abstract

Cough, cough receptors, and asthma in children

Chang

1999

Pediatr. Pulmonol.

143

View full text Add to dashboard Cite

This review discusses current general concepts on cough and the relationship between cough, cough receptor sensitivity, and asthma in children. It presents models of the relationship between cough and bronchoconstriction, and proposes a new model outlining the relationship between cough receptor sensitivity, airway hyperresponsiveness, and the clinical issues of cough, wheeze, and dyspnea in children with and without asthma. Cough is very common in children, with a prevalence of 15–20%. Those with non‐specific cough (dry cough in the absence of identifiable respiratory illness) are often treated with a variety of drugs, in particular, medications for asthma and gastroesophageal reflux. However, there is little evidence to use these medications for the sole symptom of cough in children. Clinical studies on cough need to be interpreted in light of inherent methodological problems in studying cough. These methodological problems include the nonrepeatable nature of questions on cough, the unreliability of subjective measurements of cough, the lack of objective measurements to quantify cough severity, and the period effect (spontaneous resolution of cough). Although cough can be troublesome, cough serves as an important function for maintaining normal health of the respiratory system. The importance of cough in maintaining respiratory health is reflected in the development of lung atelactasis/collapse from retained secretions and recurrent pneumonia in clinical situations where the cough reflex is ineffective. The cough reflex is complex and still poorly understood. In this article the simplified cough pathway is presented and involves cough receptors, mediators of sensory nerves and the afferent pathway, the vagus nerve, the cough centre, efferent pathway, and cough effectors. Pediatr Pulmonol. 1999; 28: 59–70. © 1999 Wiley‐Liss, Inc.

show abstract

Sputum in severe exacerbations of asthma: kinetics of inflammatory indices after prednisone treatment.

Cited by 258 publications

References 29 publications

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Safety of sputum induction in chronic obstructive pulmonary disease

Cough, cough receptors, and asthma in children

Contact Info

Product

Resources

About