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PubMed1999

Prednisone-dependent asthma: inflammatory indices in induced sputum.

The kinetics of changes in inflammatory indices in induced sputum from eight prednisone dependent asthmatics whose minimum clinical maintenance and exacerbation doses were known were investigated. The study began on the last day of a course of 30 mg prednisone daily for one week. Thereafter, the daily prednisone was reduced in a structured way to below the maintenance dose. This treatment was continued until a clinical exacerbation occurred. Prednisone 30 mg daily was then given again for one week. The mean duration of prednisone reduction was 7.4 weeks and the median dose was 7.5 mg x day(-1). Increases in sputum eosinophils preceded increases in blood eosinophils by 4 weeks and worsening of symptoms and forced expiratory volume in one second by 6 weeks. The clinical exacerbation was also accompanied by sputum neutrophilia and increases in sputum eosinophil cationic protein (ECP), fibrinogen and interleukin (IL)-5. Treatment with prednisone suppressed median sputum eosinophilia (from 16.3 to 0%, p<0.001), decreased sputum ECP (from 7,480 to 700 microg x L(-1), p = 0.01), but did not improve neutrophil numbers, fibrinogen or IL-5. The results show that the reduction of prednisone treatment in prednisone-dependent asthmatics evokes a severe airway eosinophilic inflammatory response. Clinical and blood indices deteriorate later than those in sputum suggesting that sputum examination may be useful to identify the minimum regular dose of prednisone required in these patients.

Adult↗
PubMed1998

Detection of K-ras point mutations in sputum from patients with adenocarcinoma of the lung by point-EXACCT.

PURPOSE: Kirsten ras (K-ras) point mutations are found in 30% to 56% of pulmonary adenocarcinomas by means of highly sensitive techniques. Recently, the Point-EXACCT (point mutation detection using exonuclease amplification coupled capture technique) method was described, which detected one cell with a mutation in 15,000 normal cells. The aim of this study was to examine whether K-ras point mutations could be found with this rapid method in the sputum of patients with adenocarcinoma of the lung. PATIENTS AND METHODS: DNA from paraffin-embedded adenocarcinoma and corresponding sputum samples were analyzed for mutations of the K-ras gene. Twenty-eight biopsy specimens and 54 sputum samples of 22 patients were used for amplification and K-ras codon 12 point mutation detection. RESULTS: In 11 of 22 patients (50%), a mutation in K-ras codon 12 was shown in the tumor sample. In five of 11 patients (45%) with a K-ras mutation in the tumor, the same type of mutation was identified in at least one sputum sample. A mutation could not be detected in any of the sputum samples from patients with a K-ras-negative tumor. Time between K-ras point mutation detection in sputum and clinical diagnosis of lung cancer varied from 1 month to almost 4 years. In two of the five patients with K-ras-positive sputum specimens, malignant cells were found with cytologic examination. CONCLUSION: Point-EXACCT is suitable for the detection of K-ras point mutations in sputum samples of patients with adenocarcinoma of the lung. This approach may be an important adjunct to cytology in the early diagnosis of lung cancer.

Adenocarcinoma↗
PubMed2003

Effect of inhaled beclomethasone dipropionate on peroxynitrite inhibitory activity in induced sputum from asthmatic patients.

STUDY OBJECTIVES: We recently found that peroxynitrite inhibitory activity in induced sputum was significantly lower in asthmatic patients than in normal control subjects. Current guidelines recommend inhaled corticosteroids as first-line control therapy in asthma. Therefore, this study was designed to examine the effect of inhaled beclomethasone dipropionate (BDP) on peroxynitrite inhibitory activity in induced sputum from asthmatic patients. DESIGN: Interventional study. SETTING: University hospital. PATIENTS: Twenty-one asthmatic patients and 10 age-matched, normal control subjects. INTERVENTIONS: Inflammatory indexes in induced sputum were examined in all study subjects, and peroxynitrite inhibitory activity was also assayed by monitoring rhodamine formation. For 8 weeks after the first sputum induction, BDP 400 microg bid, was administered to all asthmatic patients and sputum induction was repeated. MEASUREMENTS AND RESULTS: Nitrite and nitrate levels in induced sputum were significantly higher in asthmatic patients (1,121 micro mol/L [SD, 205 micro mol/L], p < 0.0001) than in normal control subjects (642 micromol/L [SD, 137 micromol/L]). In contrast, peroxynitrite inhibitory activity in induced sputum was significantly lower in asthmatic patients (50.0% [SD, 25.7%], p < 0.0001) than in normal control subjects (93.0% [SD, 3.6%]). After 8 weeks of BDP therapy, nitrite and nitrate levels were significantly decreased (847 micromol/L [SD, 143 micromol/L], p < 0.0001) and peroxynitrite inhibitory activity was increased (73.9% [SD, 19.2%], p = 0.0005). Moreover, the increase in peroxynitrite inhibitory activity from before to after BDP therapy was significantly correlated with decrease in nitrite and nitrate levels (r = 0.79, p = 0.0004). We also found the significant relationship between increase in peroxynitrite inhibitory activity in induced sputum and increase in FEV(1) percentage of predicted after BDP therapy (r = 0.68, p = 0.0023). CONCLUSIONS: Large amounts of peroxynitrite, which are exaggerated in acute asthma attacks, might overwhelm endogenous antioxidant defenses. However, inhaled corticosteroid therapy enhanced antioxidant activity against peroxynitrite, and therefore might reduce the susceptibility to peroxynitrite-induced injury in asthmatic airways.

Administration, Inhalation↗
PubMed2006

Clinical applications of induced sputum.

The development of standardized methods for sputum induction has improved the quality and reproducibility of sputum samples. This technique has been used to optimize samples in the investigation of pulmonary tuberculosis and lung cancer, but its clinical application as a noninvasive measure of airway inflammation has highlighted the enormous potential of this technique. Sputum induction has allowed researchers to characterize the inflammatory profiles of a variety of airway diseases including asthma, COPD, and chronic cough. To date, the identification of sputum eosinophilia has the greatest clinical value as this predicts a favorable response to corticosteroids and can therefore guide treatment. In asthma and COPD management, protocols aimed at normalizing the sputum eosinophil count have markedly reduced exacerbations without an overall increase in therapy. Currently, no other noninvasive measure of airway inflammation has demonstrated a benefit in reducing exacerbations. The value of sputum induction and analysis is not restricted to the recognition of sputum eosinophilia but also may be used to direct novel antineutrophilic therapies. Thus, it is time for sputum induction to move from the research laboratory to the clinic.

Asthma↗
PubMedDate not supplied

Informing the TB suspect for sputum sample collection and communicating laboratory results in Nicaragua: a neglected process in tuberculosis case finding.

OBJECTIVE: To assess the patient information process before sputum sample collection, the quality of sputum sample and transmission of acid-fast bacilli (AFB) examination results to TB suspects, in three local areas of Nicaragua. METHODS: (a) directed interviews of consecutive series of TB suspects whose sputum had been examined for AFB; (b) directed interview of health personnel; and (c) assessment of the sputum sample quality. RESULTS: A total of 115 TB suspects and 33 health personnel were interviewed and 625 sputum samples were assessed. Results show multiple weaknesses in the process of information to the patient during sputum collections, as well as in the communication of results. CONCLUSIONS: This study unveiled an aspect usually overlooked of case finding, that is, the information process during sputum production, sputum sample quality, and the communication of results to the TB suspects. The results illustrate the need for routine assessment of the whole diagnostic process.

Adolescent↗
PubMedDate not supplied

Comparison of expectorated sputum after manual chest physical therapy and high-frequency chest compression.

This study is a quantitative comparison of the sputum produced by 12 subjects with cystic fibrosis (CF) who received high-frequency chest compression (HFCC) and standard chest physical therapy (CPT) in randomized order. Six subjects routinely used manual CPT and six routinely used the HFCC. None had acute infections or hospitalization in the six weeks before the study. Two certified respiratory therapists alternated subjects and CPT vs HFCC order during the two weeks of the matched study. For all sessions, the expectorated sputum was collected in preweighed cups, which were reweighed immediately after collection and again after evaporation to dryness. The wet and dry weights of the sputum produced as a result of the two techniques were significantly different, with HFCC having greater weight. Regardless of the mode of therapy, the sputum produced by the subjects who regularly received HFCC had greater water content than did the sputum produced by those subjects who regularly received CPT. No significant difference was found between the two therapists regarding sputum expectorated by the subjects during CPT. These results show that sputum production by subjects with CF who receive CPT by certified respiratory therapists can be as great as the sputum produced by the same subjects who receive HFCC. The results also suggest that unknown factors attributed to the therapists may produce different levels of effort from time to time that may decrease the respiratory therapists' effectiveness, whereas the HFCC therapy may be more consistently effective because it is entirely machine based.

Chest Wall Oscillation↗
PubMed2004

[Sputum analysis in patients with "disharmony of stomach"].

OBJECTIVE: To analyze the amount and inflammatory components of the sputum in patients with "disharmony of stomach", including gastroesophageal reflux disease, peptic ulcer and chronic gastritis. METHODS: Sputum production was induced by inspiration of aerosol of 3.5% hypertonic saline with ultrasonic nebulizer, and the total cell count in the sputum was examined. Sputum smear stained with Gimsa was used in differential counting under light microscope. Bacterial culture in the sputum was performed in the usual way. Peak expiratory flow (PEF) was tested to study the airway responsiveness. RESULTS: The amount of sputum, the total cells and eosinophils in the sputum of the patients with "disharmony of stomach" were higher than those of the control. PEF decreased following sputum induction. These parameters returned to control level after treatment with Chinese herbs. Bacterial culture was negative. CONCLUSION: "Disharmony of stomach" can cause the bronchial inflammation (non-infection) characterized by eosinophil increase.

Adult↗
PubMedDate not supplied

Does eosinophil cationic protein in sputum and blood reflect bronchial inflammation and obstruction in allergic asthmatics?

In the assessment of asthma severity and monitoring of asthma drug therapy, eosinophils and eosinophil cationic protein (ECP) have been identified in blood but rarely in sputum. The aim of our study was to determine if ECP concentrations in blood and sputum reflect bronchial inflammation and obstruction in allergic asthmatics and if inhaled steroids influence this relationship. We carried out a descriptive, cross-sectional study of 42 allergic asthmatic outpatients from a respiratory medicine department, of whom 22 were on beta 2-adrenergic agonists only and 20 were treated with low doses of inhaled steroids. Spirometry and methacholine challenge were performed and eosinophils and ECP values in induced sputum and blood were determined. The age and FEV1 were similar in both groups. It was found that in patients receiving inhaled steroids, the methacholine PD20 was higher than in patients on beta 2-adrenergic agonists only. However, there were no significant differences in serum and sputum ECP between the groups (median 14.5 micrograms/l vs. 17.2 micrograms/l and 235 micrograms/l vs. 301 micrograms/l, respectively). In patients not receiving steroids, sputum ECP correlated positively with eosinophils in sputum (r = 0.61, p < 0.01) and inversely with FEV1 (r = -0.43, p < 0.05). Serum ECP correlated with blood eosinophils and methacholine PD20. In patients treated with inhaled steroids most correlations were no longer significant. We concluded that ECP in sputum, rather than in blood, seems to reflect both eosinophilic inflammation and bronchial obstruction in asthmatics not receiving inhaled steroids. Asthmatics on low doses of inhaled steroids had increased ECP levels in sputum and serum, indicating persistent eosinophilic inflammation of the airways.

Adrenergic beta-Agonists↗
PubMed1999

Sputum induction to improve the diagnostic yield in patients with suspected pulmonary tuberculosis.

OBJECTIVE: To evaluate the utility of sputum induction in the large-scale tuberculosis control program. METHODS: Prospective study on sputum induction for improving the diagnostic yield of pulmonary tuberculosis, and estimation of the direct costs for sputum induction. RESULTS: Of 1,648 tuberculosis suspects with poor or absent sputum production, induced sputum was smear-positive in 558 patients (353 previously smear-negative, 97 inadequate sputum and 108 unproductive). The direct cost per induced sputum was US $0.37. CONCLUSION: Sputum induction is an effective, low-cost, and simple technique for improving the smear-positive case detection rate in a tuberculosis control program.

Adolescent↗
PubMed1999

Diagnosis of tuberculosis in sputum negative patients in Dar es Salaam.

OBJECTIVE: To determine diagnostic criteria for tuberculosis among sputum smear acid fast bacilli negative patients with chronic cough, based on symptoms, signs and simple laboratory tests. DESIGN: A two-month prospective follow up study. SETTING: Muhimbili Medical Centre, Dar es Salaam, Tanzania. SUBJECTS: One hundred and seventy- eight consecutive patients admitted between 1st November, 1994 and 31st March, 1995 with chronic productive cough. MAIN OUTCOME MEASURES: Sputum smear acid fast bacilli (AAFB) negative with TB, discriminating ability of clinical and laboratory parameters. RESULTS: Forty three (24.2%) were sputum smear positive for acid fast bacilli (AAFB). In 90 (50.6%) patients, AAFB could be isolated in specimen other than sputum and in 45 (25.3%) no AAFB could be isolated. In a univariate analysis of all symptoms, signs and laboratory test results, cough of four or more weeks, haemoptysis, oral candidiasis, chest consolidation, pleural effusion, mid zone and upper zone chest x-ray opacities were significantly different between sputum AAFB negative TB and non TB patients. Discriminant analysis revealed six highly significant variables: Mantoux reaction, pleural effusion, Kaposi's lesion, cervical lymphadenopathy, matted lymph node, mid zone and upper zone CXR infiltrates. From these variables an equation was derived to calculate the probability that a sputum smear negative patient had tuberculosis. Then a scoring system was developed that classified correctly 84% of cases of sputum AAFB negative patients into tuberculosis or non tuberculosis. CONCLUSION: In sputum smear AAFB negative patient clinically suspected to have tuberculosis, Mantoux reaction, cervical lymphadenopathy, matted lymph nodes, absence of mid lower zone infiltration on CXR and presence of pleural effusion could be used for presumptive diagnosis, but they would not make a therapeutic trial unnecessary.

Adult↗
PubMed2001

Detection of Mycobacterium tuberculosis from sputum collected on filter paper and stored at room temperature for 5 days by PCR assay and culture.

UNLABELLED: The efficacy of PCR assay and culture for direct detection of M. tuberculosis (MTB) from sputum specimens collected on filter paper and stored at room temperature for 5 days was evaluated in comparison with conventional culture of fresh sputum specimen. A total of 231 sputum specimens were examined. MTB was recovered from 124 samples by culture from fresh sputum samples before storage. The culture positivity rate was significantly decreased to 70 per cent after 5 day's storage on filter paper. For PCR assay, a fragment of 377-bp of the IS6110 sequence was amplified and detected using nested PCR. Compared with culture results performed on fresh sputum samples, the sensitivity, specificity, and efficiency for the nested PCR were 96.0, 97.2 and 96.5 per cent, respectively. The nested PCR showed sensitivity and specificity with no significant difference (p>0.05) from culture of fresh sputum specimens. CONCLUSION: The collection and storage of sputum on filter paper at room temperature for 5 days had no apparent effect on the performance of nested PCR. Sputum samples collected by this method could be sent by post in a minimum of space and inexpensive way and will enable a large number of samples collected in the field or from peripheral health centers to be sent to central laboratories for analysis by trained technicians and under a well-equipped and well-established quality control system. The rapid and reliable detection by PCR-based assay will be helpful for optimal patient management of therapy and effective control of tuberculosis.

Bacteriological Techniques↗
PubMed2003

Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatment.

SETTING: Studies have shown that adverse outcomes are more likely in patients showing persistent sputum positivity at the end of 2 months of anti-tuberculosis treatment. OBJECTIVE: To identify simple clinical, microbiological or radiological factors associated with persistent sputum positivity under national programme conditions. DESIGN: Sputum smear-positive pulmonary tuberculosis patients admitted in 2 consecutive years to a referral hospital, and who received standard short-course chemotherapy under direct observation, were reviewed retrospectively. Factors associated with persistent sputum smear positivity were analysed. RESULTS: A total of 514 patients were available for review. Logistic regression analysis showed that age groups 41-60 years and more than 60 years, numerous bacilli on initial sputum smear examination, and presence of multiple cavitary diseases were significant factors associated with persistent sputum positivity at the end of 2 months of treatment (P < 0.0001). CONCLUSIONS: Identification of high risk factors associated with persistent sputum positivity, such as specific age groups, numerous bacilli on initial sputum smear examination, and presence of multiple cavitary diseases, may be helpful in stratifying the patients according to the risk of adverse outcome, thus allowing greater efficiency in resource utilisation.

Adult↗
PubMed2003

[Diagnostic value of postbronchoscopic sputum, bronchoscopic lavage, and transbronchial biopsy in peripheral lung cancer].

The aim of this prospective study was to review the value of bronchoscopic lavage, transbronchial biopsy and postbronchoscopic sputum cytology in peripheral lung cancer. Two groups of patients were involved in the study who were treated in our clinic between the years 1999 and 2001: Group I (22 patients; average age 64 +/- 9 years; 18 males and four females) whose lesions were peripherally localised on chest radiographs and Group II (28 patients; average age 61 +/- 8; 26 males and two females) whose lesions were centrally localised and were visible only by diagnostic bronchoscopic procedures. The following procedures and analysis were done in all patients: Cytologic analysis of prebroncoscopic sputum, bronchoscopic lavage, bronchial biopsy, and patients were asked to give sputum in 30 minutes after bronchoscopy. The final diagnosis of all patients was primary lung cancer. In the first group none of the patients had visible endobronchial lesion on fiberoptic bronchoscopy. Sputum cytology of the patients were negative before bronchoscopy. Bronchoscopic lavage cytology was positive in five of 22 patients (22.7%). Transbronchial biopsy provided better diagnostic yield (50%) than postbronchoscopic sputum (31.8%). In the second group of patients, cytologic analysis was positive 25%, 96.4% and 42.9% in bronchoscopic lavage, bronchial biopsy and postbronchoscopic sputum respectively. Our findings suggest that postbronchoscopic sputum cytology may be an important diagnostic procedure in endoscopically nonvisible pulmonary cancer. Since its application is easy and noninvasive, cytologic analysis of postbronchoscopic sputum may be preferable to bronchoscopic biopsy although a favorable diagnostic yield is not expected.

Aged↗
PubMed2005

[Safety of sputum induction in subjects with acute exacerbations of chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the safety of sputum induction in subjects with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). METHODS: Twenty-two patients with AECOPD were enrolled in the study. All subjects inhaled a mist of 3% hypertonic saline solution and the forced expiratory volume in one second (FEV(1)) and pulse oxygen saturation (SpO(2)) were measured during the procedure. RESULTS: A significant fall in SpO(2) and FEV(1) was found during sputum induction by inhalation of 3% hypertonic saline solution. Mean decline in SpO(2) during sputum induction was (2.1 +/- 0.4)% (P < 0.01) and recovered within 10 min after cessation of sputum induction. Mean decline in FEV(1) during sputum induction was (12.3 +/- 3.1)% (P = 0.027), an absolute fall of (0.11 +/- 0.03) L, and the FEV(1) returned to the baseline in all subjects within 10 min after cessation of sputum induction. The sputum induction was successful in 19 of the 22 (86%) patients. CONCLUSION: The use of a standardized sputum induction protocol is relatively safe in sampling the lower airways in patients with AECOPD.

Aged↗
PubMed2005

[Changes of leukotriene B4 in induced sputum and plasma of patients with chronic obstructive pulmonary disease and the effects of theophylline].

OBJECTIVE: To investigate the changes of leukotriene B(4) (LTB(4)) in induced sputum and plasma of patients with chronic obstructive pulmonary disease (COPD) and the effects of theophylline. METHODS: The investigation was a prospective, randomized controlled trial. Forty stable COPD patients (group C) were randomized into a subgroup receiving oral theophylline 0.2 g twice a day for one month (group CA) and a subgroup receiving no theophylline (group CB). Fifteen age-matched healthy non-smokers (group H) were included as controls. The following measurements were performed at baseline for each group and one month later for group C: symptom and life quality scores, pulmonary function, cell counts and cell differentials in induced sputum, and concentrations of interleukin-8 (IL-8) and LTB(4) in both induced sputum and plasma by using enzyme linked immunosorbent assay (ELISA) and enzyme immunoassay (EIA). RESULTS: Concentrations of LTB(4) in induced sputum [(794 +/- 305) pg/mg x pro] and plasma [(5,219 +/- 1,185) ng/L] in group C were significantly higher than those in group H [(347 +/- 169) pg/mg x pro, (2,283 +/- 489) ng/L, all P < 0.05]. The level of LTB(4) in induced sputum was positively correlated with the percentage of neutrophil (r = 0.453, P = 0.018) and IL-8 (r = 0.364, P = 0.047). The pre-and post-therapy concentrations of LTB(4) in induced sputum and plasma in group CA were (812 +/- 592), (657 +/- 459) pg/mg x pro and (5,422 +/- 935), (4,589 +/- 1,057) ng/L, respectively; while in group CB the concentrations were (776 +/- 227), (860 +/- 194) pg/mg x pro and (5,074 +/- 1,850), (6,063 +/- 2,450) ng/L, respectively. There were no significant changes either in the level of LTB(4) in induced sputum or in plasma in both groups (all P > 0.05). CONCLUSIONS: The results suggest that LTB(4) is involved in airway inflammation in COPD. Theophylline is not effective in decreasing the levels of LTB(4) in both induced sputum and plasma of COPD patients.

Aged↗
PubMed2005

[Range of the normal values for induced sputum cells in Silesian population].

BACKGROUND: The induced sputum is used in the diagnosis of chronic airways diseases. Up to now there has not been performed studies in Poland describing the distribution of cells in sputum. The aim of the study was to work out the range of normal values for cells in sputum, based on a group of healthy Polish people living in Silesia region. METHODS: One hundred healthy volunteers in age 17-79 without respiratory symptoms were examined. They had normal spirometry, no airways hyperresponsiveness to metacholine and no history of allergic diseases. The sputum was obtained from 85 people. Viability, total and differential cell counts was performed. RESULTS: The range of the normal values for induced sputum cells was following [mean (+/- SD)]: macrophages 49.3% (11.5-77.1%), neutrophils 48.5% (9.6-87.2%), eosinophils 0.8% (<4.8), lymphocytes 1.4% (<4.2%). Smoking and age of subjects influenced the number and percentage of cells in sputum. CONCLUSIONS: Finding of high percentage of eosinophils (>4.8%) in sputum may be helpful in the diagnosis of asthma. Counting of neutrophils and other cells is of limited practical value. E.S.; G.G.; A.S.; A.B.; W.P. Range of the normal value for induced sputum cells in people living in Silesian region.

Adolescent↗
PubMed1988

Gram stain and culture of morning and 24 h sputum in the diagnosis of bacterial exacerbation of chronic bronchitis: a dogma disputed.

Bacteriological results from microscopic and cultural examinations of morning and 24 h sputum were compared in an attempt to optimize the diagnosis of bacterial exacerbations of chronic bronchitis. Twelve patients collected sputum randomly on two consecutive days, either fresh morning sputum (3 h sputum) first, followed by 24 h sputum or vice-versa. Sputa were washed three times in 0.9% NaCl and then examined microscopically before and after homogenization with 2% pancreatin. Cultural examinations were performed on homogenized sputum. Haemophilus influenzae, pneumococci and neisseriae were identified more often in Gram stains than in cultures; staphylococci and Gram-negative rods less frequently so. About 50% of organisms microscopically identified as pneumococci failed to grow in cultures. Microscopic examinations revealed a marked reduction of cells and bacteria after homogenization with pancreatin. Gram stains of 24 h sputum show comparable results to those of morning sputum. No differences were found in cultures. Microscopic examination of the Gram stains was found to be superior to cultural examination. The value of microscopic examination was impaired by the addition of pancreatin.

Bacterial Infections↗
PubMedDate not supplied

Diagnostic significance of "severe dysplasia" in sputum cytology.

The diagnostic significance of a cytologic diagnosis of "severe dysplasia" on sputum samples was assessed. In a group of 46 patients with diagnoses of severe dysplasia, follow-up showed no malignancy of the lung in 25 patients (54%) and a malignant process in 21 patients (46%). These groups were compared to 52 patients with correct negative and 202 patients with correct positive sputum diagnoses. Of the patient characteristics investigated, age, previous sputum production, vital capacity and low forced expiratory volume were not significantly related to a sputum cytodiagnosis of severe dysplasia. In contrast, severe dyspnea showed a significantly higher frequency in patients with a sputum cytodiagnosis of severe dysplasia, but without an underlying malignant lung process. Follow-up disclosed a malignant tumor in 10 of 13 patients with disease; the presence of severely dysplastic cells in sputum specimens from such patients should be considered a warning signal for an underlying malignant lung process. Since severe dysplasia should be considered a premalignant epithelial lesion, patients with sputum cytodiagnoses of severe dysplasia should undergo bronchoscopy, with multiple bronchial brushings of all areas showing suspicious mucosal changes, together with segmental bronchial washings. In case a malignant process cannot be located, sputum examinations should be repeated at three-month intervals.

Age Factors↗