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PubMed1997

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

We have investigated the time-course of symptoms, forced expiratory volume in one second (FEV1), and the airway inflammatory changes in sputum selected from saliva and blood of 10 patients with severe exacerbation of asthma betwen presentation and after 1, 2, 3, 7, and 21 days of treatment. The sputum was induced by a modified standard protocol, and we examined its safety. The severe exacerbation of asthma was defined by the presence of nocturnal symptoms disturbing sleep and/or the need for inhaled short acting beta2-agonist > or = 8 puffs/d and an FEV1 after bronchodilator < 60% of predicted. The treatment consisted of additional prednisone 30 mg daily for 5 d followed by reduction to zero by day 10. Abnormal findings [median (interquartile range)] in spontaneous and induced sputum included low viability of cells [52.0 (34.0)%]; eosinophilia [20.0 (16.4)%]; many free eosinophil granules; and increased levels of fluid-phase ECP [1960 (9204) microg/L], fibrinogen [6045 (10720) microg/L], and IL-5 [160 (212) pg/ml]. Peripheral blood eosinophils [10.4 (7.6)%] and ECP levels [34.0 (35.0) microg/L] were increased. After treatment, symptoms, FEV1, blood eosinophilia, and serum ECP improved in the first 24 h. Sputum eosinophils and ECP did not improve until 48 h and fibrinogen not until 7 d. The improvement in sputum eosinophils and ECP levels was correlated with improvement of FEV1 and in fluid-phase IL-5. Thirty sputum inductions were performed safely in the majority with inhaled isotonic or 3% saline (23.3% or 63.3%, respectively) over a short duration (mean 8.4 min). The patients who had a fall in FEV1 of > or = 10% (10 occasions) after induction differed from those with a fall of < 10% only in the amount of inhaled beta2-agonist used by the patients in the preceding 24 h [8.0 (5.0) versus 4.0 (3.0) puffs/d, p = 0.01]. The results suggest that spontaneous or induced sputum can be used safely to follow the kinetics of effects of antiinflammatory treatment in a severe exacerbation of asthma. The clinical and blood indices improve before those in sputum, raising the possibility that examination of sputum is a better guide in these patients to follow the effects of treatment.

Adolescent↗
PubMed1997

Safety of one method of sputum induction in asthmatic subjects.

To assess the safety of sputum induction in asthmatic subjects, we conducted a retrospective review of data from 351 sputum inductions in 78 subjects from our institution. The sputum induction protcol consisted of baseline FEV1, pretreatment with albuterol 180 micrograms, postbronchodilator spirometry 15 min later, the induction procedure itself (inhalation of 3% saline for 20 min), and postsputum induction spirometry. We found that sputum induction was usually well tolerated, although some subjects developed wheeze and dyspnea. Overall, 11 of the 78 subjects (14%) had a fall in FEV1 of > or = 20% from the postbronchodilator baseline ("excessive bronchoconstriction") during their first sputum induction (range: -20 to -69%); no subject developed refractory bronchoconstriction requiring hospitalization or emergency room treatment. Only one of the 54 subjects (1.9%) with a baseline prebronchodilator FEV1 > 80% had excessive bronchoconstriction, whereas 10 of the 24 subjects (42%) whose baseline FEV1 was < or = 80% predicted did so. The change in FEV1 during sputum induction was significantly correlated with the baseline prebronchodilator FEV1% predicted, the baseline postbronchodilator FEV1% predicted, the PC20 for methacholine, and the percentage of eosinophils in induced sputum. We conclude that 180 micrograms albuterol does not prevent excessive bronchoconstriction in all asthmatic subjects undergoing sputum induction, especially in asthmatic subjects with a low baseline FEV1. Pulmonary function should be monitored regularly during sputum induction in asthmatic subjects to monitor for excessive bronchoconstriction.

Adult↗
PubMed2000

Sputum cysteinyl leukotrienes increase 24 hours after allergen inhalation in atopic asthmatics.

We have used the relatively noninvasive technique of induced sputum to measure allergen-induced changes in the concentration of eicosanoid mediators in bronchial secretions from atopic asthmatics. Sputum induction was performed before and 24 h after inhalational allergen challenge in 14 atopic asthmatics who developed a late asthmatic reaction (LAR). Differential cell counts were made on sputum cytospins and eicosanoid (cysteinyl leukotrienes [cys LTs], prostaglandin D(2) [PGD(2)], and PGE(2)) concentrations were measured in the sputum supernatants. The percentage of eosinophils at baseline correlated with the concentration of cys LTs (r = 0.84, p < 0.001) but not prostanoid mediators. Allergen challenge produced a significant increase in the concentration of sputum cys LTs from 3. 45 ng/ml sputum to 11.95 ng/ml (p = 0.002), which correlated with the increase in sputum eosinophils (r = 0.55, p < 0.05). There were no significant changes in PGD(2) or PGE(2) concentrations in sputum supernatants in response to challenge. Thus, the noninvasive technique of induced sputum has been used to demonstrate increased cys LTs, but not prostanoids associated with LAR after allergen challenge. The correlation between eosinophil numbers and cys LT concentrations at baseline values and 24 h after allergen challenge is consistent with these cells being a principal source of cys LTs within the airways at these time points.

Adult↗
PubMed1978

Chemical markers of mucous and serum glycoproteins and their relation to viscosity in mucoid and purulent sputum from various hypersecretory diseases.

Mucus and serum are always present in sputum. The concentrations of their markers were measured in mucoid and purulent sputum from patients with chronic bronchitis, asthma, cystic fibrosis, or bronchiectasis. Differences in the concentrations of both mucous and serum glycoproteins were greater among different macroscopic types of sputum than among diseases for the same macroscopic type. Comparison between diseases showed that sputum from patients with asthma had the widest variation in concentrations of markers of mucous glycoprotein and dry macromolecular weight. When the asthma group was further analyzed, it became apparent that patients with extrinsic asthma without chronic bronchitis represented a homogeneous group, whereas those with intrinsic asthma, with or without chronic bronchitis, were responsible for the wide variation. The concentrations of markers of mucous and serum glycoproteins in a sputum sample were correlated with the apparent viscosity of the sputum to establish the relative contribution of the glycoproteins to the viscosity of sputum. In mucoid sputum, the mucous glycoprotein was most important in determining the viscosity, whereas when in infected sputum, both mucous and serum components contributed to the viscosity.

Asthma↗
PubMed1984

Charcot-Leyden crystal protein and eosinophil granule major basic protein in sputum of patients with respiratory diseases.

Sputum eosinophilia is characteristic of bronchial asthma, and sputum specimens from patients with asthma contain eosinophil-derived substances including Charcot-Leyden crystals (CLC) and the eosinophil granule major basic protein (MBP). Prior observations have indicated that an elevated sputum level of MBP is associated with asthma. To determine whether CLC protein was also elevated in asthma, we measured by specific radioimmunoassays the quantities of MBP and CLC protein in sputum specimens from 106 consecutive patients with various respiratory diseases and in sputum specimens from 10 patients hospitalized for asthma. The CLC protein was detected in all sputum samples, and the levels in the 116 samples averaged 3.5 micrograms/ml (range, 0.01 to 25 micrograms/ml). The CLC protein was significantly elevated in sputum specimens from patients with acute asthma and from patients with certain other respiratory diseases when associated with bronchopulmonary infection. In contrast, MBP levels in the 116 samples averaged 0.32 micrograms/ml (range, 0.01 to 8.8 micrograms/ml) and were significantly elevated only in patients with asymptomatic or acute asthma. Sputum MBP was not elevated in patients with bronchopulmonary infections unless acute asthma was also present. Thus, an elevated sputum MBP level was specifically associated with asthma, whereas an elevated CLC protein level was associated with both asthma and with bronchopulmonary infection in certain patient groups.

Asthma↗
PubMed1986

The usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome.

Thirty-two patients with or suspected of having the acquired immunodeficiency syndrome were evaluated for opportunistic lung infection using examination of sputum induced by inhalation of 3% saline. The specimens obtained were stained with Giemsa stain and examined for Pneumocystis carinii. Smears of sputum were also appropriately stained and examined for acid-fast organisms and fungi, as well as cultured for these organisms. Patients whose sputum did not contain P. carinii had bronchoscopy within 24 h of sputum induction. Twenty-five of the 32 patients were ultimately determined to have P. carinii pneumonia. Of these, 14 were detected by examination of sputum (sensitivity, 56%). Of 18 patients whose sputum did not contain P. carinii, 11 had the organism detected in specimens obtained by bronchoscopy (negative predictive value, 39%). There were no clinical features that identified patients more likely to have a positive sputum examination. No additional treatable lung pathogens appeared to be missed by sputum examination. In this select population, examination of induced sputum establishes the diagnosis of P. carinii pneumonia in a significant proportion of patients, thereby decreasing the need for more invasive procedures.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Comparison of induced sputum with bronchial wash, bronchoalveolar lavage and bronchial biopsies in COPD.

It is unclear how cellular and soluble inflammatory markers in induced sputum relate to markers in lavage fluid and biopsies in chronic obstructive pulmonary disease (COPD). This was investigated and also the possible differences between subjects with COPD and healthy controls assessed. Eighteen nonatopic subjects with COPD and 11 healthy controls were studied. Sputum was induced by inhalation of hypertonic saline. The airways were lavaged, using the first 50 mL for bronchial wash (BW) and the subsequent 150 mL for bronchoalveolar lavage (BAL), and biopsies were taken from subsegmental carinae. Neutrophils were the predominant cell type in sputum in COPD (median 77.3%) but not in BW (5.5%) and BAL fluid (1.7%). Differential cell counts in sputum did not correlate with the counts in BW or BAL fluid or biopsies, whereas sputum eosinophil cationic protein (ECP) levels correlated with BW fluid ECP levels (p=0.66, p=0.007) and sputum interleukin-8 (IL-8) concentration with BAL fluid IL-8 concentration (p= 0.52, p=0.026). Subjects with COPD had a higher percentage of sputum neutrophils and eosinophils and higher concentrations of ECP and IL-8 than healthy controls. The higher percentages of eosinophils and concentrations of ECP were also seen in BW and BAL fluid. Finally, higher numbers of macrophages and eosinophils were found in biopsies. In conclusion, induced sputum is derived from a different compartment from BW and BAL fluid and biopsies. Induced sputum may be useful for studying the contribution of luminal neutrophils and eosinophils in chronic obstructive pulmonary disease.

Adult↗
PubMed2003

Induced sputum IL-8 gene expression, neutrophil influx and MMP-9 in allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to the fungus Aspergillus fumigatus, causing severe asthma that may progress to bronchiectasis. Sputum neutrophilia can occur in association with sputum eosinophilia and correlates with the degree of bronchiectasis. The mechanisms of sputum neutrophilia in ABPA are not known. The aim of this study was to investigate the role of the chemokine interleukin (IL)-8 in sputum neutrophilia in ABPA. Induced sputum was obtained from subjects with ABPA (n=29), and compared to nonsensitised asthma (n=9) and healthy controls (n=21). Semiquantitative polymerase chain reaction was used to assess IL-8 gene expression in induced sputum and IL-8 protein was measured by enzyme-linked immunosorbent assay. Sputum IL-8 protein was significantly higher in ABPA compared to asthma and controls. IL-8 messenger ribonucleic acid/glyceraldehyde-3-phosphate dehydrogenase ratio was elevated in ABPA compared to asthma and controls. Sputum IL-8 correlated with sputum neutrophils, matrix metalloproteinase-9 levels and forced expiratory volume in one second. Interleukin-8 gene expression and protein release were increased in allergic bronchopulmonary aspergillosis and correlated with airway neutrophilia and airway obstruction. The interleukin-8-mediated neutrophil influx in allergic bronchopulmonary aspergillosis may induce lung damage via release of matrix metalloproteinase-9, potentially leading to bronchiectasis.

Adult↗
PubMed1996

Relevance of asbestos bodies in sputum.

The presence of asbestos bodies (ABs) in sputum specimens of individuals with occupational asbestos exposure has been well-documented. The aim of this study was to determine their clinical relevance in comparison to the concentration of AB in bronchoalveolar lavage (BAL) and lung tissue. Subjects were included following a well-documented exposure of asbestos history (n = 93) or BAL fluid analysis positive for ABs (n = 42). The subjects with a well documented history of AB exposure were divided into three groups: heavy (Group 1, n = 29); moderate (Group 2, n = 31); or occasional exposure (Group 3, n = 33). BAL fluid was available from all subjects, and lung tissue from 21 subjects. To assess the variability, 10 sputum positive subjects collected subsequent sputum on days 2, 7, 14, 30 and 90. ABs were determined by light microscopy after membrane filtration of specimen digests. The mean sputum AB content was highest in Group 1 (2.4 +/- 5.5 AB.mL-1), lower in Group 2 (0.2 +/- 0.3 AB.mL-1) and lowest in Group 3 (0.1 +/- 0.1 AB.mL-1) suggesting a correlation with cumulative exposure. However, many negative sputum samples were noted, when BAL specimens were positive. The AB content of sputum and BAL specimens did not correlate. ABs were found in sputum of all subjects with a tissue content of > 1,000 AB-cm-3, but in none with contents of < 1,000 AB-cm-3. Substantial variability of ABs was found in the five sequentially collected sputa of 10 initially positive patients (coefficient of variation 28-93%), but only two false negatives were found in these 50 samples. Thus, sputum analysis for asbestos bodies is an insensitive method for assessing the lung asbestos burden, much less sensitive than bronchoalveolar lavage fluid analysis. However, a sputum sample positive for asbestos bodies is suggestive of a high lung asbestos burden.

Aged↗
PubMed1998

Induced sputum, bronchoalveolar lavage and blood from mild asthmatics: inflammatory cells, lymphocyte subsets and soluble markers compared.

Airway inflammation in asthma can be measured directly by invasive bronchoalveolar lavage (BAL), directly and relatively noninvasively by induced sputum and indirectly from peripheral blood. We compared cellular and fluid phase indices of inflammation in induced sputum, BAL and blood from 11 adults with mild stable asthma. On one day, induced sputum selected from saliva was collected and on the next, blood and BAL. Median results of sputum compared with BAL showed a higher number of nonsquamous cells (53 versus 0.8 x 10(6) cells x mL(-1), p=0.003), more neutrophils (34.3 versus 1.0%, p<0.001), CD4+ and CD19+ T-cells (76.5 versus 54.7%, p=0.01 and 5.2 versus 1.1%, p=0.03, respectively), fewer macrophages (603 versus 95.0%, p=0.002) and markedly higher levels of eosinophil cationic protein (ECP) (264 versus 2.0 microg x L(-1), p<0.001), tryptase (17.6 versus 2.2 UI x L(-1), p<0.001) and fibrinogen (1,400 versus 150 microg x L(-1), p=0.001). Sputum and BAL neutrophils and CD4+ T-cells were strongly correlated. Sputum and BAL differed from blood by having higher proportions of T-cells (94.9 and 98.9% versus 87.7%, p=0.002) and lower proportions of CD19+ T-lymphocytes (p=0.04 and 0.006). Sputum also differed from blood by having higher proportions of CD4+ T-cells (76.5 versus 51.4%, p=0.001), lower proportions of CD8+ cells (24.0 versus 403%, p=0.04) and a higher CD4+/CD8+ ratio (3.3 versus 1.4, p=0.01). We conclude that in mild asthmatics, sputum, bronchoalveolar lavage and blood measure different compartments of inflammation. Induced selected sputum has the advantage over bronchoalveolar lavage of higher density of cell recovery and stronger signal for fluid-phase markers.

Adult↗
PubMed1999

Induced sputum in adolescents with severe stable asthma. Safety and the relationship of cell counts and eosinophil cationic protein to clinical severity.

This study examined the safety of sputum induction and the relation between sputum cell counts and clinical parameters in adolescents with severe persistent asthma. Within 5 days, induced sputum and reversibility in forced expiratory volume in one second (FEV1), quality of life, provocative concentration causing a 20% fall in FEV1 (PC20) of adenosine monophosphate and histamine, exercise-induced bronchoconstriction, overall asthma severity index, and blood eosinophils were collected in 20 atopic adolescents with moderate-to-severe persistent asthma (12-18 yrs of age, FEV1 65-110% of predicted, on 500-2,000 microg inhaled steroids daily). FEV1 was reversible by 13.3-2.3% pred. After sputum induction, FEV1 was still increased by 9.0+/-2.6% pred as compared to the pre-salbutamol baseline. Sputum contained, median (range): 12.4 (0.4-59.5)% squamous cells, 47.3 (6.8-84.0)% macrophages, 39.0 (4.6-84.8)% neutrophils, 4.8 (1.0-12.4)% lymphocytes, 0.4 (0-10.8)% eosinophils and 3.6 (0-23.4)% bronchial epithelial cells. Sputum eosinophils showed a trend towards a significant association with the overall asthma severity index (r=0.46, p=0.06) and correlated inversely with baseline FEV1 (r=-0.51, p=0.03). In conclusion, sputum can be induced safely in adolescents with moderate-to-severe persistent asthma, if pretreated with beta2-agonists. Despite relatively low sputum eosinophil counts in these patients on inhaled steroids, the association of eosinophil numbers with baseline forced expiratory volume in one second and asthma severity index favours a role of induced sputum in monitoring adolescents with severe asthma.

Adolescent↗
PubMed1992

Sputum cytology-positive, bronchoscopically negative adenocarcinoma of the lung.

Among a total of 114 cases of resected lung adenocarcinoma that were examined by sputum cytologic study before bronchoscopy, 17 were sputum cytology-positive, but had no abnormal bronchoscopic findings. In most of these cases, the reason for detection was sputum and bloody sputum (58.8 percent). Pathologically, many cases were classified as stage III A or more (82.4 percent) due to mediastinal lymph node metastases. More than 70 percent of the cases showed vascular invasion. The proportion of well-differentiated cases was also high (52.9 percent). The prognosis of these cases was worse than sputum cytology-negative adenocarcinoma without abnormal bronchoscopic findings and better than sputum cytology-positive adenocarcinoma with abnormal bronchoscopic findings. There was no significant difference between these cases and sputum cytology-negative adenocarcinoma with abnormal bronchoscopic findings. Combined with the bronchoscopic findings, sputum cytologic study is useful for preoperative evaluation of lymph node metastasis and prognosis. This combined approach can provide information necessary to perform sufficient dissection of mediastinal lymph nodes and proper adjuvant therapy in sputum cytology-positive adenocarcinoma cases, even though there are no abnormal bronchoscopic findings.

Adenocarcinoma↗
PubMed1997

A comparison of peak sputum tobramycin concentration in patients with cystic fibrosis using jet and ultrasonic nebulizer systems. Aerosolized Tobramycin Study Group.

STUDY OBJECTIVE: To determine whether adequate concentrations of a new formulation of tobramycin could be delivered to the lower respiratory tract of patients with cystic fibrosis (CF) using a jet nebulizer delivery system. DESIGN: A multicenter, open-label, randomized, crossover study. SETTING: Ten tertiary care, university-affiliated, teaching hospitals in the United States. PATIENTS AND CONTROL SUBJECTS: Sixty-eight patients recruited from 10 CF Foundation centers and who were at least 8 years of age, had a diagnosis of CF, and expectorated daily sputum. No control subjects enrolled. INTERVENTIONS: Each patient received one administration of aerosolized tobramycin from each of the three nebulizer systems in random order. Each administration was separated by a minimum of 48 h. The two jet nebulizer systems tested were the Sidestream (Medic-Aid; Sussex, UK), and the Pari LC (Pari Respiratory Equipment; Richmond, Va), with a DeVilbiss Pulmoaide compressor (DeVilbiss Health Care; Somerset, Pa), both administering 300 mg tobramycin in 5 mL of 1/4 normal saline solution (NS). Patients were also administered 600 mg tobramycin in 30 mL of 1/2 NS with the UltraNeb 99/100 (DeVilbiss). MEASUREMENTS: Sputum and serum tobramycin concentration and pulmonary function were monitored. An adequate peak sputum tobramycin concentration was defined as > 128 microg/g sputum at any of three time points (10, 60, or 120 min) after completion of treatments. RESULTS: The peak tobramycin concentrations in expectorated sputum were 687+/-663 microg/g (mean+/-SD) with the Pari LC and 489+/-402 microg/g with the Sidestream. Adequate peak sputum tobramycin concentration was achieved in 93% of the patients with the Sidestream, and in 87% of the patients with the Pari LC. Peak sputum concentrations were found to be substantially higher when patients received tobramycin administered with the UltraNeb 99/100, 1,498+/-1,331 microg/g with 30% of patients having levels exceeding 2,000 microg/g. Serum tobramycin concentrations were < or = 4 microg/mL for all patients following administration with each nebulizer. CONCLUSIONS: Adequately high sputum tobramycin concentrations were documented in sputum in > 85% of patients following the administration of 300 mg/5 mL formulation of tobramycin aerosolized by the two jet nebulizer delivery systems, Sidestream and Pari LC. The single tobramycin administration delivered by these two systems is well-tolerated.

Adolescent↗
PubMed2006

Low sputum eosinophils predict the lack of response to beclomethasone in symptomatic asthmatic patients.

BACKGROUND: The prognostic role of low sputum eosinophils in steroid-naïve, symptomatic asthmatic patients is controversial. AIM: To verify whether low sputum eosinophils predict poor response to treatment with inhaled corticosteroids. METHODS: Sixty-seven symptomatic asthmatic patients with moderate asthma were examined before and after 2 weeks and 4 weeks of treatment with beclomethasone dipropionate, 500 microg bid. None received corticosteroids in the 3 months preceding the study. At each visit, all patients underwent spirometry, methacholine challenge, and sputum induction. The patients recorded symptom scores and peak expiratory flow (PEF) throughout the study. RESULTS: Seventeen patients had low sputum eosinophils despite being symptomatic. Patients with high (> 3%) sputum eosinophils at baseline showed significant improvement in symptoms, pulmonary function, and bronchial hyperresponsiveness after treatment, whereas patients with low sputum eosinophils showed no significant improvement in most clinical and functional outcomes. Among the baseline indexes examined, sputum eosinophils had the highest negative predictive value but low positive predictive value for the response to treatment. Multiple stepwise regression showed that only baseline FEV(1) and sputum eosinophil percentages significantly correlated with changes in FEV(1) after treatment. CONCLUSIONS: We suggest that, among the indexes examined, low sputum eosinophils are the best predictor for poor corticosteroid effects in asthma.

Adult↗
PubMed2003

Nitric oxide metabolites, eosinophils, and eosinophilic cationic protein in patients with asthma: sputum versus blood.

The monitoring of airway inflammation has assessed in bronchial asthma directly by sputum examination, and indirectly by measurements in peripheral blood. To investigate the diagnostic value of these two methods, we compared nitric oxide (NO) metabolites, eosinophils, and eosinophil cationic protein (ECP) in sputum and blood in patients with asthma and control subjects. Sputum and serum were obtained from fifteen patients with asthma, and then were examined before anti-asthma treatment, including steroid preparations. ECP was measured by fluoroimmunoassay. NO metabolites were assayed by using modified Griess reaction. Asthmatic patients, compared with control subjects, had significantly higher level of NO metabolites, higher proportion of eosinophils, and higher levels of ECP in sputum. Asthmatic patients, compared with control subjects, however, had significantly higher number of eosinophils, and were at higher levels of ECP in blood. FEV1, FEV1/FVC was negatively correlated with sputum eosinophils. The area under receiver operating characteristic (ROC) curve showed that eosinophils in sputum are significantly accurate markers than NO metabolites in sputum and blood. These findings suggest that the proportion of eosinophils in sputum have more accurate diagnostic marker of asthmatic airway inflammation than NO metabolites in sputum in differentiating asthmatic patients from control subjects.

Adult↗
PubMed1988

Rapid noninvasive diagnosis of Pneumocystis carinii from induced liquefied sputum.

Pneumocystis carinii organisms cluster in alveolar casts. A method for concentrating alveolar casts in sputum specimens might improve the diagnostic usefulness of sputum studies in possible cases of pulmonary infection with Pneumocystis carinii. The use of sputum induction to detect Pneumocystis carinii was studied in 40 consecutive patients with known or suspected human immunodeficiency virus infection having bronchoscopy for evaluation of pulmonary disease. Sputum produced by deep coughing induced by 3% saline via a jet nebulizer was liquefied with dithiothreitol, and cells were sedimented and stained. Liquefaction of mucus allowed concentration of alveolar casts where P. carinii cysts were readily identified. A total of 28 patients were found to have P. carinii, which was detected in concentrated sputum in 21 of 38 patients, unconcentrated sputum in 10 of 38 patients, and by bronchoscopy in 25 of 37 patients. Sensitivity of concentrated sputum compared with bronchoscopy was 78% (95% CI, 58 to 90), with a negative predictive value of 71% (95% CI, 47 to 87). Values for unconcentrated sputum were 43% (95% CI, 25 to 63) and 48% (95% CI, 30 to 67), respectively. Liquefaction of adequately induced sputum facilitates processing and interpretation and increases yield for P. carinii, eliminating the need for invasive procedures in most patients.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Benefits of induced sputum for the evaluation of therapeutic efficacy in patients with bronchial asthma.

Airway inflammation is a major factor in the pathogenesis of asthma. Inducing sputum by hypertonic saline is a noninvasive method of assessment of the airway inflammation in asthmatic patients. To investigate sputum induction as a method for assessing airway inflammation and to evaluate the effect of inhaled beclomethasone dipropionate (BDP) in asthmatic patients, we examined the bronchial hyperresponsibility (BHR), pulmonary function and differential cell counts in induced sputum of the patients before and after BDP therapy. In asthmatic patients, the percentage of eosinophils in induced sputum was significantly higher than that in non-asthmatic subjects. Ten patients with atopic asthma (four men and six women; mean [+/- SD] age, 30.5 +/- 12.4 years) participated. Their mean percentage of eosinophils (% eosinophils) in induced sputum fell from 22.9 +/- 7.2% to 13.9 +/- 8.3% (p < 0.05) by 3 months of BDP treatment. The percentage of eosinophils in induced sputum before BDP treatment was significantly correlated with the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV1%) at baseline (r = -0.75, p < 0.05), but not with log Dmin at baseline (p = 0.18). The change in FEV1% between at baseline and post-treatment correlated significantly with the change in the sputum eosinophil percentage (r = -0.79, p < 0.01). In addition, there was a significant correlation between the change of log Dmin and the change of the sputum eosinophil percentage (r = -0.64, p < 0.05). In conclusion, analysis of induced sputum is a safe, noninvasive, repeatable and useful method to assess the clinical condition of bronchial inflammation in patients with bronchial asthma.

Administration, Inhalation↗
PubMed1998

The value of fluorescence microscopy of auramine stained sputum smears for the diagnosis of pulmonary tuberculosis.

Laboratory diagnosis of pulmonary tuberculosis rests on the bacteriological examination of sputum smears stained by the Ziehl-Neelsen (ZN) method for acid fast bacilli (AFB). In the present study, we have compared light microscopy of ZN stained smears with that of fluorescence microscopy of sputum smears stained by auramine-phenol flurochrome dye for detection of AFB in sputum specimens. Sputum specimens from a total of 2,600 clinically suspected and diagnosed cases of pulmonary tuberculosis were examined by both the methods. Sputum specimens from a total of 1,104 patients were found to be positive for AFB. These included sputa from 975 (37.5%) patients positive for AFB by both ZN and auramine staining methods and sputa from an additional 129 (4.96%) patients positive for AFB by auramine staining only. Thus auramine staining of sputum smears in comparison to that of ZN staining is a better method of sputum microscopy for demonstration of AFB in sputum specimens. Fluorescence microscopy is relatively more sensitive and has the added advantage of allowing a large number of sputum specimens to be examined in a given time, in laboratories equipped with a fluorescent microscope.

Bacteriological Techniques↗