Induced sputum and response to glucocorticoids,☆☆,

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Abstract

Jerry Dolovich has generated substantial new work that has had an international impact on the understanding and treatment of asthma and other airway diseases. For this, he is recognized as a Distinguished Clinician of the American Academy of Asthma, Allergy and Immunology. I have focused on some of his recent work with us using induced sputum to measure indices of airway inflammation noninvasively. The results illustrate that sputum eosinophilia (1) does not necessarily correlate with the severity of symptoms or severity of abnormalities of airway function, (2) does not always occur in exacerbations of asthma, and (3) may be a predictor clinical benefit to steroid treatment, which will be useful in practice. The observations imply that airway inflammation needs to be measured to understand the pathogenesis, pathophysiology, and treatment of asthma and other airway diseases. (J Allergy Clin Immunol 1998;102:S102-5.)

Section snippets

INDUCED SPUTUM EXAMINATION

Sputum examination for indices of airway inflammation is not new. At around the time that Osler10 published his first textbook, The Principles and Practice of Medicine , and drew attention to the presence of inflammation in asthma, Gollasch11 identified eosinophils in the sputum of patients with asthma. There was a renewed interest in the examination of sputum in the 1950s, but its use in practice and research did not catch on because it was considered to be difficult, and the results were

SPUTUM CELL COUNTS AND CLINICAL FEATURES OF ASTHMA

The clinical features of asthma and other airway diseases are considered to be secondary to airway inflammation and the remodeling that results. It would therefore be reasonable to consider that relationships might be observed between the presence or severity of the inflammation and the clinical features. In an early study using induced sputum, this was observed13 ; the greater the sputum eosinophilia, the more severe the symptoms and the worse the airflow limitation and methacholine airway

SPUTUM CELL COUNTS AND EXACERBATIONS IN ASTHMA

Further evidence that direct measurements of inflammation are needed comes from studies of uncontrolled asthma or exacerbations of asthma and comparing the measurements with interpretations based on clinical parameters. Turner et al,28 when recruiting for a treatment study, found that about one quarter of the volunteers with uncontrolled symptoms of asthma had little or no eosinophilia. Fahy et al29 also observed that the majority of patients seen in the emergency department with a severe

SPUTUM CELL COUNTS AND RESPONSE TO STEROID TREATMENT

Although it is recognized that airway eosinophilia is common in asthma and that glucocorticoid treatment reduces eosinophilia in general and generally improves asthma, the association between eosinophilia and the effect of glucocorticoids in airway disease has generally been overlooked. Induced sputum examination has now provided a tool by which the antiinflammatory effects of medications can be studied easily.

In a series of studies with Jerry, Marcia and Emilio Pizzichini, and others, we have

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    From the Department of Medicine, McMaster University, Hamilton.

    ☆☆

    Reprint requests: Frederick E. Hargreave, MD, FRCP(C), FRCP, Firestone Regional Chest & Allergy Unit, McMaster University and St Joseph’s Hospital, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6.

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