Induced sputum and response to glucocorticoids☆,☆☆,★
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
References (36)
- et al.
Late cutaneous allergic responses in IgE-dependent reactions
J Allergy Clin Immunol
(1973) - et al.
Bronchial responsiveness to histamine or methacholine in asthma: measurement and clinical significance
J Allergy Clin Immunol
(1981) - et al.
Immunocytochemical detection of granulocyte-macrophage colony stimulating factor and eosinophil cationic protein in sputum cells
J Allergy Clin Immunol
(1994) - et al.
Measuring airway inflammation in asthma: eosinophils and ECP in induced sputum compared with peripheral blood
J Allergy Clin Immunol
(1997) - et al.
Chronic cough: eosinophilic bronchitis without asthma
Lancet
(1989) - et al.
The late phase of the immediate wheal and flare skin reaction
J Clin Invest
(1996) - et al.
Allergen-induced increase in non-allergic bronchial reactivity
Clin Allergy
(1977) - et al.
Late asthmatic responses
Am Rev Respir Dis
(1987) - et al.
Bronchoalveolar eosinophilia during allergen-induced late asthmatic reaction
Am Rev Respir Dis
(1985) - et al.
The asthma syndrome: inciters, inducers and host
Thorax
(1981)
Use of induced sputum cell counts to investigate airway inflammation in asthma
Thorax
The assessment and treatment of asthma: a conference report
J Allergy Clin Immunol
The principals and practice of medicine
Zur kenntniss der asthmatischen sputums
Fortschritte der Medizin (Berlin)
Cellular characteristics of sputum from patients with asthma and chronic bronchitis
Thorax
Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid phase measurements
Am J Respir Crit Care Med
Cytokine expression in normal, atopic and asthmatic subjects using the combination of sputum induction and the polymerase chain reaction
Thorax
Elevated B cells in sputum of asthmatics: close correlation with eosinophils
Am J Respir Crit Care Med
Cited by (26)
Asthma outcomes: Biomarkers
2012, Journal of Allergy and Clinical ImmunologyCitation Excerpt :With increasing recognition of specific molecular phenotypes of asthma associated with specific cellular profiles, this advantage is becoming even more relevant. Coupled with emerging data that responsiveness to treatment such as corticosteroids or cytokine inhibitors depends on patterns of cellular inflammation in the airway82,97,98 and that cellular inflammation is associated with specific patterns of airway remodeling,76,77,80 it becomes clear that mechanism- or treatment-oriented studies in asthma are best done with full knowledge of the airway cytology phenotype. Weaknesses include participant tolerance, the salty taste of the hypertonic saline, the small risk of bronchoconstriction, the difficulty in obtaining adequate samples in some study participants (particularly children), and the need to participate actively in sputum expectoration.
Phenotypic predictors of long-term response to inhaled corticosteroid and leukotriene modifier therapies in pediatric asthma
2009, Journal of Allergy and Clinical ImmunologySputum eosinophils and the response of exercise-induced bronchoconstriction to corticosteroid in asthma
2008, ChestCitation Excerpt :Only high-dose ICS therapy significantly suppressed sputum eosinophil percentage counts. Previous studies131415 have shown that sputum eosinophils are a marker for the response to ICS therapy in patients with nonexercise asthma. Our study is the first to show that sputum eosinophils also predicted a response in EIB and the temporal relationship of EIB response to different dose levels of ICSs.
Airway inflammation assessed by invasive and noninvasive means in severe asthma: Eosinophilic and noneosinophilic phenotypes
2006, Journal of Allergy and Clinical ImmunologyExamination of induced sputum: A method for monitoring the control of asthma
2004, Revue Francaise d'Allergologie et d'Immunologie Clinique
- ☆
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.
- ★
0091-6749/98 $5.00 + 0 1/0/93905