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PubMed2000

Noninvasive assessment of airway inflammation in children: induced sputum, exhaled nitric oxide, and breath condensate.

Noninvasive markers of airway inflammation are needed for use in research and clinical practice in childhood asthma. Induced sputum and exhaled nitric oxide are well established as direct markers of inflammation for use in asthma research. Sputum can be induced from children of >6 yrs using inhalation of hypertonic saline, and, if appropriate, can be combined with an assessment of airway responsiveness to hypertonic saline. The success rate of sputum induction in children is 68-100%. Most studies have processed sputum using the plug selection method, and show that the dominant cell in sputum from normal children is the macrophage, and that the upper normal limit for sputum eosinophils in children is 2.5%. The inflammatory response in childhood asthma is characterized by elevated numbers of sputum eosinophils, and eosinophil cationic protein concentration, as well as increased nitric oxide and hydrogen peroxide levels in exhaled breath. Sputum eosinophils correlate with objective markers of disease severity in steroid-naive children with asthma, and in severe asthma. Inflammatory marker levels are lower in children using glucocorticosteroids. Induced sputum and exhaled gases are important markers of inflammation in childhood asthma. The clinical utility of these markers warrants further study.

Breath Tests↗
PubMed1999

[The changes of NO2-./NO3-. level in sputum from patients with asthma and their clinical implications].

OBJECTIVE: To evaluate the clinical applications of the detection of the stable end products of NO, nitrite and nitrate (NO2-./NO3-.) in sputum from patients with asthma. METHODS: 45 patients with asthma at remission (group I, n = 15) or exacerbation state with mild attack (group II, n = 15) or moderate to severe attack (group III, n = 15), 15 cases of chronic cor pulmonale secondary to chronic bronchitis at exacerbation (group IV), and 20, normal control subjects (group V n = 20) were included in this study. NO2-./NO3-. in sputum and serum were measured by Griess reaction, while the eosinophil cationic protein (ECP) in sputum and pulmonary function were also measured in tested patients with asthma. RESULTS: The median concentrations of sputum NO2-./NO3-. in group I, II and III were 85, 131 and 136 mumol/L respectively, all were significantly higher than that in controls (63 mumol/L); those of group II and III were significantly higher than that of group I, while that of group IV (33 mumol/L) was significantly lower than those of the asthmatic groups and the control. The level of NO derivatives in sputum was closely correlated with the degree of airflow obstruction and sputum ECP levels in patients with asthma at remission (r = -0.587, P < 0.05; r = 0.535, P < 0.01 respectively) and exacerbation (r = -0.485, P < 0.05; r = 0.563, P < 0.05 respectively). There was no significant correlation between serum and sputum NO2-./NO3-., and no significant correlation between serum NO2-./NO3-. and the degree of airflow obstruction. A significant decrease in the concentration of sputum NO2-./NO3-. was observed after therapeutic treatment of patients with moderate to severe attack (136 vs 93 mumol/L). CONCLUSION: The level of NO2-./NO3-. in sputum may be a useful marker for monitoring the state of airway inflammation and assessing the therapeutic efficacy.

Adult↗
PubMed2003

Neutrophilic inflammation in induced sputum of patients with idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology. Biopsy and bronchoalveolar lavage studies have shown, that accumulation of inflammatory cells, particularily neutrophils, in the alveolar space is a relevant feature of the pathogenesis of IPF. This paper adresses the issue of whether the safe and non-invasive method of sputum induction is a suitable tool to study respiratory tract inflammation in IPF. METHODS: In a cross-sectional analysis, 15 IPF patients and 14 healthy, non-smoking subjects underwent sputum induction. Total sputum cell counts, differentials, and the amount of interleukin (IL)-8, granulocyte-macrophage-colony stimulating factor (GM-CSF), and soluble ICAM-1 (sICAM) in sputum supernatant were analyzed. RESULTS: IPF patients had increased sputum neutrophils (60 +/- 6 vs 22 +/- 3%, p = 0.0003), and supernatant concentrations of IL-8 (19 +/- 3 vs. 7 +/- 1 ng/ml, p = 0.0002), GM-CSF (205 +/- 43 vs. 122 +/- 36 pg/ml, p = 0.08) and sICAM (12 +/- 3 vs. 5 +/- 3 ng/ml, p = 0.01), when compared with healthy controls. Sputum IL-8 was correlated with sputum neutrophils (rho = 0.61, p = 0.0006) in all patients. The extent of sputum neutrophilia was also correlated with lung function impairment (vital capacity, % of predicted) in IPF patients (rho = -0.68, p = 0.007). CONCLUSION: These data confirm the established role of neutrophilic inflammation in the pathogenesis of IPF, and show the potential of induced sputum to directly study inflammatory processes and surrogate markers in interstitial lung diseases like IPF.

Adult↗
PubMed2002

[The influence oc glycocorticoid therapy on sputum ECP concentration in symptomatic patients with bronchial asthma].

UNLABELLED: ECP released from the granules of activated eosinophils is regarded to be a marker of airway inflammation in asthma. The study was performed to compare the usefulness of measuring serum and sputum ECP for monitoring the asthma treatment. 29 subjects with mild to moderate asthma (mean age 41 +/- 17) were admitted in exacerbation (FEV1 55.54 +/- 87.49% N). 10 subjects with grass pollen asymptomatic asthma and 10 healthy subjects were also enrolled in the study. Patients with symptomatic asthma were ordered 30 mg prednisone for 2 weeks and they continued during next 2 weeks inhaled budesonide therapy. The concentrations of ECP (mcg/L) were determined by CAP-system (Pharmacia). The total eosinophil count and serum ECP in all subjects treated orally and next by inhaled GKS didn't differ statistically. The highest sputum ECP concentration was determined in exacerbation of asthma 84.5 +/- 78 mcg/L and statistically were reduced after 2-weeks of prednisone treatment 24.4 +/- 12.1 mcg/L (p = 0.05). In following 2 weeks of budesonide treatment sputum ECP concentration was statistically negligible in relation to previous treatment in spite of increasing tendency (50 +/- 61.3 mcg/L (p = 0.2394). In asymptomatic grass pollen asthma sputum ECP concentration was 19.7 +/- 9.4 mcg/L, higher than in controls 12 +/- 5.8 mcg/L (p = 0.04). There were a significant correlations between total eosinophil count and serum (r = 0.6396) and sputum ECP(r = 0.4683) in exacerbation. CONCLUSIONS: 1. In asthma exacerbation elevated sputum ECP concentration was observed. 2. In consequence of prednisone treatment the sputum ECP concentration was reduced. 3. Sputum ECP measurement is more accurate than serum ECP for monitoring the effectiveness of treatment. 4. Sputum ECP concentration is a sensitive parameter which discriminate asymptomatic patients with asthma from healthy subjects.

Adult↗
PubMed2005

[The small airway inflammation of asthmatic patients who have used dry powder type inhaled steroid for moderate-long term evaluated by induced sputum and the efficacy of HFA-BDP (QVAR) inhalation].

UNLABELLED: Although the dry powder type inhaled steroids, such as Fluticasone Propionate Diskhaler (FP-DH), FP Diskus (FP-DK), Budesonide Turbuhaler (BUD-TH), are widely distributed in daily clinical fields, we clinicians are required to evaluate whether it is effectively inhibiting inflammation of distal airway or not. We also investigated the effect of Hydrofluoroalukan-beclomethasone dipropionate (HFA-BDP), a new type of inhaled steroid which forms super micro aerosol particles, in the distal small airway. METHOD: 85 patients with moderate asthma, who daily used dry powder type inhaled steroid for at least more than 6 months with stable asthmatic condition, were the subject of this study. All subjects underwent sputum induction with the inhalation of 10% of hypertonic saline solution for 15 min and eosinophil counts and eosinophil cationic protein (ECP) in individual induced sputum were measured. Then, patients who had eosinophils detected in their induced sputum changed their previously inhaled steroid to HFA-BDP inhalation (400 i.g./day). Their eosinophil counts and the values of eosinophil cationic protein (ECP), Eotaxin, RANTES and neutrophil elastase (PMN-E) in their induced sputum were also examined before and 4weeks after changing HFA-BDP inhalation. RESULT: Increased eosinophils were found in the induced sputum of 40.5% patients of the FP-DK group, 36.3% of the FP-DH group and 32.4% of the BUD-TH group, respectively. Compared with group of patients in which no sputum eosinophil were detected, the sputum ECP values, in which sputum eosinophils were detected, were significantly high. 4 weeks after changing to HFA-BDP inhalation, eosinophil counts, ECP, Eotaxin, RANTES and PMN-E in their induced sputum were decreased in every group. CONCLUSION: Compared with the ordinary dry powder type inhaled steroids, HFA-BDP can effectively diminish distal airway inflammation, suggesting the possibility that HFA-BDP can effectively reach to the distal small airway by forming super micro aerosol particles.

Administration, Inhalation↗
PubMedDate not supplied

[Induced sputum in children and adolescents with asthma: safety, clinical applicability and inflammatory cells aspects in stable patients and during exacerbation].

OBJECTIVES: To determine the safety of sputum induction in asthmatic children and adolescents, to characterize sputum inflammatory cells while clinically stable and during exacerbation and to correlate sputum inflammatory cells with peripheral blood eosinophils, serum IgE and the degree of bronchial obstruction. METHODS: Ninety-six asthmatic patients aged 6 to 18 years were recruited for the present cross-sectional study. Spirometry was performed before and after administration of a bronchodilator. Sputum was collected spontaneously or after induction by the inhalation of saline solution at increasing concentrations. Blood samples were obtained for serum IgE and eosinophil quantification. RESULTS: Sputum samples adequate for analysis were obtained from 68 (70.8%) of the patients recruited. No relevant bronchoconstriction was observed during induction. The presence of a larger number of eosinophils in sputum did not correlate with more clinically severe asthma. No correlation was observed between the degree of bronchial obstruction, measured based on FEV1, and inflammatory cells in sputum, peripheral blood eosinophils or serum IgE. Larger numbers of neutrophils were observed in the asthma exacerbation group (p < 0.05). CONCLUSIONS: Sputum induction was found to be a safe procedure for obtaining clinical samples from children and adolescents even during exacerbations, allowing for clinical and functional limitations. The 67% induction success rate was considered satisfactory. In this group of patients, receiving inhaled corticosteroids, eosinophil quantification did not distinguish between the clinical and functional severity of asthma and was independent of the degree of airway obstruction. A proportional predominance of neutrophils was observed in the sputum of patients with asthma exacerbation.

Adolescent↗
PubMed2006

[Number of concentrated sputum smears needed to adequately assess infectivity of patients with pulmonary tuberculosis].

PURPOSE: Investigating the usefulness of 3rd concentrated sputum smear for assessments of infectivity of pulmonary tuberculosis patients. OBJECT AND METHOD: Retrospective study of the results of diagnostic 3 consecutive concentrated-sputum-smear (fluorochrome stain) of culture-proven pulmonary tuberculosis cases at our hospital from Jan. 2002 to Sep. 2003. RESULT: Altogether 362 cases were available for analysis, and 306 (84.0%) cases were smear-positive on 3 consecutive sputum tests. Of these cases, 26 cases (8.6% of smear-positive cases) were firstly smear-positive by the 3rd sputum. Of 278 cases that were already smear-positive at first and/or second sputum smear, 40 cases (13.2% of smear-positive cases) showed the highest smear-positive grade at 3rd sputum-smear, but only 6 cases (2.0% of smear-positive cases) had smear-positive grade higher by two-grade (+/- to more than 2+, or 1+ to 3+). CONCLUSION: From the results of this study together with literature review, sensitivity of 2 concentrated sputum-smear tests by fluorochrome stain is presumed to be same as, or better than that of 3 direct sputum-smear tests by Ziehl-Neelsen stain. We have to re-consider the number of concentrated sputum smear tests needed to assess the infectivity of pulmonary tuberculosis.

Adolescent↗
PubMed2006

Resonance of sputum spigot with air vibration.

A mathematical model calculation has been presented on the resonant frequency of the oscillating sputum spigot in a cylindrical pipe, with which we investigated similar phenomena in bronchial tubes. We confirmed the theoretical results by two types of experiments using pseudo-sputum (5 and 10% solutions of mucin) spigots instead of a human pulmonary one, and found the model was suitable for estimating the effects of clinical vibrational treatments expectorating sputum spigots plugged in small bronchi. The main points of the paper are summarized as follows. 1. The validity of the fluid model used was verified using reported experimental data of Litt and co-workers. After adjusting their data in a Casson plot, Casson fluidity was found to be the best parameter to represent viscosity of the sputum. 2. A theoretical investigation on the vibrational sputum spigots in narrow tubes was done using an analytical model calculation. From the resultant formula, which expresses the resonant frequency of the oscillation of the spigot with its physical values (the radius of the airway, the length of the spigot, the elasticity of the sputum, and the surface tension), many points became clear; for example, the resonant frequency of sputum spigot vibration in a narrow bronchial tube is too high to propagate there under the effective influence of surface tension. 3. Two experiments were performed with pseudo-sputum (5 and 10% solutions of mucin) instead of a human pulmonary one. After substituting the resonant frequencies of the pseudo-sputum spigot vibration in our tube experiment into the resultant formula derived from our analytical model calculation we estimated the elasticity values, which agreed with those from our plate experiment. The validity of our theory was strongly supported by this agreement.

Elasticity↗
PubMed2006

Sensitivity of Ziehl-Neelsen method for centrifuged deposit smears of sputum samples transported in cetyl-pyridinium chloride.

BACKGROUND & OBJECTIVES: Sensitivity of Ziehl-Neelsen (ZN) method is known to be low for liquefied sputum smears. Information on the ZN sensitivity for centrifuged deposit smears is not known. This study was carried out to determine the sensitivity of ZN method for acid fast bacilli (AFB) in centrifuged deposit smears and liquefied sputum smears made from sputum samples transported in cetyl-pyridinium chloride (CPC) solution. METHODS: Liquefied sputum smears and the corresponding centrifuged deposit smears from each of the 607 consecutive sputum samples collected from tuberculosis patients admitted to receive treatment transported in CPC were read by the same readers and their results compared with culture results. RESULTS: A significantly (P<0.001) higher proportion of samples were positive in centrifuged deposit smears (40%) compared to liquefied sputum smears (30%). The results of 341 culture-positive specimens revealed that the sensitivity of ZN method was 47 per cent using liquefied sputum smears and 63 per cent using centrifuged deposit smears (P<0.001). INTERPRETATION & CONCLUSION: Our study demonstrated that the sensitivity of ZN method for AFB in centrifuged deposit smears and liquefied sputum smears was reduced if sputum samples are transported in CPC solution.

Bacteriological Techniques↗
PubMed1991

beta-Lactamase activity in sputum and indirect pathogenicity.

beta-Lactamase activity of sputum of 39 patients with respiratory infections and that of bacterial isolates from their sputum were determined by nitrocefin method. Forty-six microbial strains (16 different species) were recovered from 39 sputum samples. The beta-lactamase activity was negative only in nine of the 46 strains. beta-lactamase-positive strains were recovered from 35 of 39 sputum samples. Of these 35 sputum samples, the beta-lactamase activity was positive in 23 and negative in 12. beta-lactamase-negative strains were recovered from 4 of 39 sputum samples, and the beta-lactamase activity was negative in all of these four sputum samples. Both beta-lactamase producing and non-producing strains were recovered in 5 of 6 sputum samples from which two to three microbes were isolated. The ratio of beta-lactamase-positive sputum sample was higher in patients who had received antibiotics than in those who had received no antibiotics. This difference was statistically significant (P < 0.025). It is possible that non-causative beta-lactamase-positive organisms enhance the pathogenicity of causative organisms that are beta-lactamase-negative.

Anti-Bacterial Agents↗
PubMed1991

Relationship between dynamic viscoelasticity and biochemical parameters in whole sputum from patients with hypersecretory respiratory diseases.

To obtain suitable biochemical parameters for measuring the dynamic viscoelasticity of sputum, we examined the relationships of the dynamic viscoelasticity with the dry weight (DW) and the contents of fucose, a parameter of airway mucous glycoprotein (AMG), and total protein (TP) and major proteins in whole sputum. The DW and TP, albumin and IgG concentrations and elastase activity were higher in purulent sputum than in mucoid-mucopurulent sputum, but there was no significant difference in the concentrations of airway wall-derived substances, such as fucose and S-IgA in the two. In mucoid-mucopurulent sputum, the dynamic viscosity (eta') and elastic modulus (G'), an indicator of dynamic elasticity, were most closely correlated with the fucose concentration (r = +0.75, and +0.74, p < 0.005 at 1 Hz) and slightly correlated with the DW, TP and S-IgA, but not with the other parameters tested. In the purulent sputum, the eta' and G' correlated with the DW and concentration of TP (r = +0.70-0.80, p < 0.005), but not with any concentrations of fucose, S-IgA or albumin. The results indicate that as parameters for estimating the dynamic viscosity and elasticity of whole sputum, fucose is useful for mucoid-mucopurulent sputum whereas DW and TP are useful for purulent sputum.

Adult↗
PubMed1991

Effect of cyclooxygenase inhibitor on excessive sputum.

Indomethacin suppository and aspirin inhalation reduced the amounts of sputum in the patients with bronchiectasis and chronic bronchitis. A 67-year-old woman with bronchiectasis received indomethacin suppository to relieve the lumbar pain. After the start of indomethacin, a reduction in the amount of sputum was observed and the volume of sputum returned to pretreatment levels after the cessation of indomethacin. Levels of cyclooxygenase products in the sputum during indomethacin was also much lower than their levels after discontinuance of indomethacin. A 64-year-old man with chronic bronchitis was also administered inhaled aspirin to control the sputum volume. Both indomethacin suppository and aspirin inhalation reduced the amounts of sputum. In addition to these cases, a 31-year-old woman with bronchial asthma was tried to control the sputum production with indomethacin, but it had no effect on the sputum volume. It is suggested that these drugs may be useful in the treatment of excessive sputum in bronchiectasis and chronic bronchitis.

Adult↗
PubMed1991

[Fundamental studies on measurement of the eosinophil cationic protein in sputum from patients with bronchial asthma].

One of the characteristics of patients with bronchial asthma is activation of eosinophils in the bronchi, which can be evaluated by measuring concentrations of the cationic granule proteins. Sputum seems to be the best material to evaluate the activation of eosinophils in the bronchi because it can be collected easily from the same patient every day even if he (she) has an asthmatic attack. Recently it has become possible to measure the concentration of the eosinophil cationic protein (ECP) thanks to the availability of the ECP RIA kit. However no fundamental studies have been carried out on the handling of sputum samples, and whether only ECP released into sputum is measured. We prepared supernatants of sputum samples according to the method of Gleich and others by adding the same volume of physiological saline, mixing it for one minute by a vortex mixer and centrifuging at 40000 Xg, 4 C, for 30 minutes. We found that the measurement of ECP is not inhibited by materials in sputum supernatants through a dilution test and a recovery test. We also found that the followings did not influence the measurement of ECP; the times of dilution, the duration from collection to handing of sputum, the solution added to sputum, and the gravity of centrifugation. In addition, it was suggested that only ECP released into sputum is measurable from the results of an electron microscopic study and the measurement of ECP after centrifugation following the addition of white blood cells to sputum.

Asthma↗
PubMed1989

The use of mucolysed induced sputum for the identification of pulmonary pathogens associated with human immunodeficiency virus infection.

We describe a system for diagnosis of pulmonary disease in the human immunodeficiency virus-infected patient using induced sputum and other diagnostic procedures. This system has been successfully used at San Francisco (Calif) General Hospital for more than 2 years. It utilizes outpatient facilities and reduces the need for bronchoscopy. Sputum induced by inhalation of 3% saline mist, mucolysed, concentrated by centrifugation, and stained by a rapid modified Giemsa stain was the first diagnostic specimen examined in 404 episodes of suspected human immunodeficiency virus-associated pulmonary disease in 358 patients. Pneumocystis carinii was found in 222 (55%) sputum specimens. In 118 episodes in which the sputum did not contain P carinii, bronchoscopy with transbronchial biopsy and/or bronchoalveolar lavage was performed and P carinii was found in 50 (42%). These 118 bronchoscopy results, as well as evaluation of the subsequent clinical course of those patients who accounted for 64 episodes of lung disease and who did not have bronchoscopy following examination of nondiagnostic induced sputum, indicated a range of sensitivity for detection of P carinii in induced sputum of 74% to 77% and a negative predictive value of 58% to 64%. Mycobacteria were recovered from 11 (6%) of the induced sputum and 6 (12%) of the bronchoscopic specimens containing P carinii. However, only oral or environmental fungi were recovered from P carinii-containing induced sputum or bronchoscopic specimens. For those patients in whom P carinii was not detected, only the bronchoscopic specimens were cultured for Mycobacteria and fungi. Potentially pathogenic Mycobacteria and fungi were recovered from 16 (23.5%) and 34 (50%), respectively, of these P carinii-negative specimens. Analysis of these results, obtained under routine practice conditions, indicates that bronchoscopy should be reserved for those patients whose induced sputum examinations do not show P carinii and that mycobacterial and fungal cultures be performed only on bronchoscopic specimens in which P carinii is not detected.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[The relationship of eosinophil viability enhancing activity in sputum and clinical symptoms in asthma].

We studied the correlation of eosinophil viability enhancing activity (EVEA) in sputum from asthmatic children and clinical symptoms. Sputum from asthmatic children and equal volume of saline were mixed with a Vortex mixer and centrifuged at 40000 G. Clear supernatants were obtained and filtered with 0.22 micron membrane filter. Periphral blood eosinophils purified by Percoll density gradient centrifugation and CD16 negative selection/ immunomagnetic beads technique were incubated with sputum extract for 4 days. Eosinophil viability was examined by staining the cells with fluorescen diacetate and propidium iodide and expressed as eosinophil viability enhancing activity (EVEA). Eosinophil cationic protein (ECP) concentrations in sputum were also measured by a radioimmunoassay. Correlation between EVEA in sputum and pulmonary functions, attack score, treatment score, or sputum ECP was determined by Spearman correlation test. Sputum EVEA was correlated 1) inversely with pulmonary functions on sampling, 2) with attack score of 2 weeks period before sampling, 3) with treatment score of 1 month to 1 week before and 1 to 2 weeks after sampling, and 4) with sputum ECP in individual cases. Sputum EVEA may serve as a suitable parameter for monitoring airway inflammation in asthma.

Asthma↗
PubMed1996

Comparison between hypertonic and isotonic saline-induced sputum in the evaluation of airway inflammation in subjects with moderate asthma.

BACKGROUND: Hypertonic saline-induced sputum has recently been used for the evaluation of airway inflammation in asthma. OBJECTIVE: To assess the effect of hypertonicity on airway inflammation. METHODS: We compared the inflammatory cell composition of hypertonic saline-induced sputum with that of isotonic saline-induced sputum in 21 asthmatic subjects and, at baseline and 30 min after each sputum induction, we measured bronchial hyper-responsiveness to methacholine as an indirect marker to detect increased airway inflammation. On two different days, the patients inhaled hypertonic saline (3-5% NaCl) or isotonic saline (0.9% NaCl) for 30 min via an ultrasonic nebulizer, while monitoring FEV1. Sputum was collected for inflammatory cell analysis. RESULTS: There was no difference in inflammatory cell percentages obtained with the two methods. Eosinophils were > 1% in 20 subjects after hypertonic saline and in 16 subjects after isotonic saline, but this difference was not statistically significant. Intraclass correlation coefficients for sputum inflammatory cells obtained with the two methods were +0.642 for eosinophils, +0.644 for neutrophils, +0.544 for lymphocytes and +0.505 for macrophages. Hypertonic saline induced bronchoconstruction in a significantly greater number of subjects than isotonic saline. Also, hypertonic saline increased bronchial responsiveness to methacholine, while isotonic saline did not. CONCLUSION: We conclude that hypertonicity does not affect sputum cell composition, suggesting that inflammatory cells in hypertonic saline-induced sputum are probably preexisting and not acutely recruited in the airways by the hypertonic stimulus. However, the bronchoconstriction and the increase in bronchial hyper-responsiveness after hypertonic saline inhalation may imply the release of inflammatory mediators. This fact must be considered in the evaluation of soluble markers of inflammation in hypertonic saline-induced sputum.

Adolescent↗
PubMed1970

A Comparison Of Sensitivity On Stool And Sputum Examination For Diagnosis Of Paragonimasis.

Detecting eggs from feces and/or sputum is probably closely associated with many factors such as degree or intensity of infection, physiological status of the host(age, eating habit and duration of residence in the area), the duration of infection for the parasite (age and reproductive activity of flukes), and methods of collecting specimens and technique of examination. Neverthless, it is difficult to determine which factor plays the most inportant role in detecting eggs except comparison of factual result obtained by standardized techniques. The purpose of the study was to find out which method would give better result for detection of eggs, and to estimate what proportion of patients would be missed when the method selected is used. On a single examination of both specimens, stool and sputum, collected from the same person, sputum examination was found to be superior to stool examination for detection of eggs; 37 of 40 egg positives had eggs in sputum whereas only 21 of 40 in stool. Repeated sputum examination on the same subject in spaced time gave higher overall egg detection rate; in the first examination for all skin reaction positives, the detection rate was 36.8%, in the second examination on those who had negative results in the first examination, it was 11.6% among 602 persons examined, and 5.3 percent of 95 persons who were negative in previous two examinations. Thus, repeated sputum examinations (three times) increased the overall detection rate to 48.5% from 36.8%. According to the result obtained through this study, it would be worthwhile to recommend repeated sputum examinations at least three times on the same subject even if collecting second and third sputum is quite difficult problem in mass survey; about 12% of total patients who can be detected as positive by three times repeated examinations shall be missed if only a single sputum examination is done.

Journal Article↗
PubMed1996

Reduction in viscoelasticity in cystic fibrosis sputum in vitro using combined treatment with nacystelyn and rhDNase.

The objective of this study was to evaluate the individual and combined effects of Nacystelyn (NAL) and rhDNase in vitro on the rheological properties of cystic fibrosis (CF) sputum. Sputum samples were collected from 11 CF patients and subjected to the following protocols: 1) negative control sample without any treatment; 2) positive control sample incubated with 0.02 ml of normal saline; 3) incubation of CF sputum with 0.02 mL DNase (25 micrograms/mL in normal saline) at 37 degrees C to achieve 2.5 micrograms/g final sputum concentration (approximately 100 nM); 4) incubation of CF sputum with 0.02 mL NAL (30.9 micrograms/mL in normal saline) at 37 degrees C to achieve 3.09 micrograms/g final sputum concentration (10 microM); and 5) combination of protocols 3 and 4 with half the concentration of each drug. The samples in protocols 2 through 5 were incubated for 30 minutes at 37 degrees C. For each protocol, spinnability by filancemeter and viscoelasticity (log G*) by magnetic microrheometer were measured at baseline and 30 minutes. Treatment of the sputum with rhDNase alone or NAL alone decreased spinnability more than control treatment with saline. Combining NAL with rhDNase at half the concentration of each drug significantly decreased spinnability more than either treatment by itself. There were no significant changes in log G* or the derivative parameters, mucociliary clearability index (MCI) and cough clearability index (CCI). The enhanced reduction in sputum spinnability by the combination of NAL and rhDNase indicates additative effects between these two mucolytic treatments. These results suggest that combined treatment with rhDNase and NAL should be considered as a potential therapy for CF patients.

Acetylcysteine↗