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PubMed1977

Usefulness of transtracheal puncture and aspiration in the bacteriological diagnosis of pulmonary tuberculosis.

Transtracheal puncture enables two samples of bronchial secretions to be taken-the product of transtracheal aspiration and simultaneously expectorated sputum (obtained in 71% of the cases)-for the purpose of testing for Mycobacterium tuberculosis in cases of suspected pulmonary tuberculosis. Two groups of patients were studied: Group I: 100 patients who were poor expectorators and who all underwent transtracheal puncture; Group II (Control): 100 patients who expectorated well or who had been given gastric lavages immediately on admission. Laboratroy analyses revealed M. tuberculosis in at least one of the samples obtained from each of the 200 patients. The authors compare the efficiency of the methods used within each group and between the two groups. Samples obtained by transtracheal aspiration and simultaneous expectoration (75% of positive results) more often contained M. tuberculosis than the other Group I samples (64% of total positive results; 64% of positive results for spontaneous sputa, 65% for gastric fluids), and as often as the Group II samples (76% of total positive results), particularly the expectoration samples (78% of positive results). Simultaneously expectorated sputum more frequently contained M. tuberculosis (82% of positive results) than transtracheal aspiration (69% of positive results). Transtracheal puncture and/or simultaneous expectoration were the only examinations revealing M. tuberculosis in 34 patients in Group I. Non-specific bacteriological findings are not relevant. However, the authors point out that this technique is not always innocuous (although no serious complications were observed in this series), and that transtracheal puncture must always be carried out by physicians trained in the technique.

Adult↗
PubMed1993

[Clinical features of bronchial asthma with mucus hypersecretion].

Fifty patients with bronchial asthma were divided into four groups according to the amount of expectoration per day: 0-24, 25-49, 50-99 and 100+ ml/day. Clinical features of patients with mucus hypersecretion (more than 50 ml/day of expectoration) were evaluated by age, severity of disease, cellular composition of bronchoalveolar lavage (BAL) fluid, and ventilatory function. 1. The proportion of patients with steroid-dependent intractable asthma (SDIA) in each group increased with increase in mucus hypersecretion. 2. Many of the patients with mucus hypersecretion (more than 50 ml/day) were over the age of 40. 3. The proportion of BAL eosinophils was significantly higher in patients with hypersecretion (more than 50 ml/day) than in those with expectoration of less than 49 ml/day. There was a significant correlation between the proportion of BAL eosinophils and the amount of expectoration per day (r = 0.48, p < 0.05). Proportions of lymphocytes and neutrophils in the BAL fluid were not related to the amount of expectoration per day. 4. There was no significant correlation between the amount of expectoration per day and ventilatory function in patients with asthma in this study.

Adult↗
PubMed1996

Evaluation of nebulised acetylcysteine and normal saline in the treatment of sputum retention following thoracotomy.

BACKGROUND: The use of acetylcysteine as a mucolytic agent is controversial. In 1962 it was claimed to be "the most effective agent ... for the liquefaction of ... secretions" but was subsequently taken off the market as a respirator solution. Normal saline, on the other hand, is becoming increasingly popular. A study was undertaken to determine which solution is more effective at clearing retained secretions following thoracotomy. METHODS: The study included 10 patients and was of single blind, two-way crossover design. Measurements taken before and after each treatment included sputum viscosity, difficulty of expectoration, weight of sputum expectorated, and oxygen saturation. RESULTS: Following nebulisation of acetylcysteine, sputum viscosity was reduced, difficulty of expectoration was reduced, the weight of sputum expectorated was increased, and oxygen saturation was increased. There were no changes after nebulisation of normal saline. CONCLUSIONS: This study shows that, following thoracotomy, nebulised acetylcysteine reduces sputum viscosity, making expectoration easier and improving oxygenation. Nebulised normal saline has no effect.

Acetylcysteine↗
PubMed2002

The pharmacologic approach to airway clearance: mucoactive agents.

The airway mucosa responds to infection and inflammation in a variety of ways. This response often includes surface mucous (goblet) cell and submucosal gland hyperplasia and hypertrophy, with mucus hypersecretion. Products of inflammation, including neutrophil-derived deoxyribonucleic acid (DNA) and filamentous actin (F-actin), effete cells, bacteria, and cell debris, all contribute to mucus purulence and, when this mucus is expectorated it is called sputum. Mucoactive medications are intended to serve one of 2 purposes; either to increase the ability to expectorate sputum or to decrease mucus hypersecretion. Mucoactive medications have been classified according to their proposed mechanisms of action. Increased knowledge of the properties of mucus has given us tools to better understand the mechanisms of airway disease and mucoactive therapy. Expectorants are thought to increase the volume or hydration of airway secretions. Systemic hydration and classic expectorants have not been demonstrated to be clinically effective. Modifiers of airway water transport are being clinically investigated as expectorants. Mucolytics degrade polymers in secretions. The classic mucolytics have free thiol groups to degrade mucin. Peptide mucolytics break pathologic filaments of neutrophil-derived DNA and actin in sputum. Nondestructive mucolysis includes mucin dispersion by means of charge shielding. Mucokinetics are medications that increase mucociliary efficiency or cough efficiency. Cough flow can be increased by bronchodilators in patients with airway hyperreactivity. Abhesives such as surfactants decrease mucus attachment to the cilia and epithelium, augmenting both cough and mucociliary clearance. Mucoregulatory agents reduce the volume of airway mucus secretion and appear to be especially effective in hypersecretory states such as bronchorrhea, diffuse panbronchiolitis, and some forms of asthma. Mucoregulatory agents include anti-inflammatory agents (indomethacin, glucocorticosteroids), anticholinergic agents, and some macrolide antibiotics. Classifying mucoactive agents should help us to develop and evaluate new types of therapy and to better direct therapy toward the patients who are most likely to benefit.

Anti-Bacterial Agents↗
PubMed2001

Airway inflammation in children with cystic fibrosis and healthy children assessed by sputum induction.

A noninvasive method to characterize inflammation and infection in the airways of nonexpectorating children with cystic fibrosis (CF) is needed for clinical and research purposes. Accordingly, we performed sputum inductions by administering 3% saline to 11 healthy control children and 20 children with CF, composed of 7 sputum producers (capable of spontaneously expectorating sputum) and 13 nonproducers. Induced sputum weights were comparable in each group, whereas the amount of induced sputum collected from the CF producers was over 10-fold higher than the spontaneously expectorated samples. We found a significant increase in indices of airway inflammation, including total cell counts, absolute neutrophil counts, interleukin-8 (IL-8) levels, and neutrophil elastase activity in the CF subjects compared with the healthy control subjects. These same indices in the induced sputum specimens from CF producers were significantly correlated with levels in the matched expectorated sputum specimens. Sputum total protein concentration was elevated in the CF groups, whereas urea and albumin levels were not significantly different. Salivary analysis, performed separately, revealed higher levels of IL-8 and total protein in the CF groups. Airway infection, as assessed by quantitative counts of CF-related bacterial pathogens, was also higher in the CF subjects. The same bacterial pathogens, in similar colony counts, were isolated from both the induced and expectorated sputum samples from the CF producers. We conclude that airway inflammation and infection, assessed through sputum induction, are significantly increased in children with CF as compared with healthy children. Furthermore, induced sputum samples are similar to spontaneously expectorated samples in describing both inflammation and infection in the CF airway.

Child↗
PubMed1993

Mucus hypersecretion and eosinophils in bronchoalveolar lavage fluid in adult patients with bronchial asthma.

Mucus hypersecretion was clinically analyzed in 46 adult patients with bronchial asthma, including 22 with steroid-dependent intractable asthma (SDIA). A large amount of expectoration, over 50 ml/day, was observed in 16 of these patients (34.8%), of whom 12 (75.0%) had SDIA and 13 (81.3%) were women. The mean amount of expectoration increased with increasing patient age, although no significant difference was found among the six age groups. A large amount of expectoration (over 50 ml/day) was clearly correlated with an increased proportion of eosinophils in bronchoalveolar lavage (BAL) fluid. The proportion of BAL eosinophils was significantly higher in patients with expectoration between 50 and 99 ml/day (p < 0.05) and over 100 ml/day (p < 0.01) than in patients whose expectoration volume was between 30 and 49 ml/day. These results show that in bronchial asthma patients, mucus hypersecretion is more often observed clinically in those with SDIA and in women, and that this hypersecretion is closely correlated with BAL eosinophilia, which is a feature of the pathophysiological changes that occur in the airways of these patients.

Adult↗
PubMedDate not supplied

[Therapeutic efficacy and general tolerability of 4-carbomethoxythiazolidine chlorohydrate in patients with exacerbated chronic bronchitis].

4-carbomethoxythiazolidine HCl has been administered to 24 patients (aged between 64 and 86) suffering from new acute stages of chronic bronchitis. The patients have been submitted to a double-blind test and have been subdivided into four groups; each of them was administered a placebo or the a.m. product. Dosage: 200, 400 and 600 mg/d. The following symptoms have been evaluated: cough; dyspnea; bronchial breathings; expectoration; expectorate's viscosity; expectorate's volume. The data have been submitted to a statistic analyses, this research leads to the followings considerations. A dosage of 200 mg/d. is not significantly active on any on the considered parameters. The 400 mg dosage turns out to be noticeably more effective than the placebo on all parameters (except the difficulty in expectoration). A dosage of 600 mg/d. has a significant effect on all the measurable parameters. Finally, a 200 mg dosage of 4-carbomethoxythiazolidine three times a day results to be the best posology in the symptomatic treatment of the respiratory manifestations of chronic bronchitis.

Aged↗
PubMedDate not supplied

Double-blind, placebo-controlled clinical evaluation of guaimesal in outpatients.

One hundred and forty outpatients, males and females aged 14 to 70 years, with acute febrile bronchitis, afebrile chronic bronchitis, or flares of chronic bronchitis were treated for seven days with one soft gelatin capsule (500 mg) of guaimesal thrice daily or matching placebo. No other potentially interfering treatment (antibiotic, antipyretic, or anti-inflammatory) was administered concomitantly. Before and after treatment, vital capacity, residual volume, and maximum expiratory volume per second were measured and recorded. Both before treatment and after 2, 4, and 7 days of treatment, body temperature was measured and cough frequency and intensity as well as expectorate amount and fluidity were scored and recorded along with the total symptom score. At the end of treatment, the overall clinical efficacy was rated and recorded. Potential side effects were monitored by questioning the patients; general safety (laboratory tests) was not monitored. All data were analyzed according to multivariate, parametric, and nonparametric statistical methods and stratified by treatment, sex, age, and diagnosis. For each monitored symptom and sign, guaimesal exhibited a favorable effect which was significantly greater in extent and significantly faster in recovery rate than that associated with spontaneous recovery. Within two days from the start of therapy, fever, cough frequency and intensity, and expectorate fluidity had significantly improved. By the fourth day the expectorate amount had significantly decreased. Further improvement was noted at subsequent times of observation. After a week, according to the spirometric parameters, the respiratory function was restored to a considerable extent. Overall, 75.7% of the patients receiving guaimesal experienced complete or almost complete recovery within the period of observation. With placebo, occasional improvement was seen for cough intensity and for expectorate amount, and this improvement was significantly less in extent and significantly slower than that recorded with guaimesal. Overall, 8.6% of placebo-treated patients experienced a clinically detectable degree of recovery. The subjective tolerance of guaimesal was comparable to that of placebo in terms of both the frequency and the nature of the side effects. Mild, transient gastric effects were reported by 11.4% of patients receiving guaimesal and by 8.6% of patients receiving placebo. These effects did not require a variation of dose or specific treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

Effects of iodopropylidene glycerol on tracheobronchial clearance in stable, chronic bronchitic patients.

We carried out a randomised, double-blind, two-period crossover study in 15 stable, chronic bronchitics to ascertain the effect on tracheobronchial clearance (TBC) of 1 week's treatment with iodopropylidene glycerol (IPG-Organidin), two tablets four times daily compared to matched placebo. TBC was measured by radioaerosol technique. The drug did not significantly alter TBC in the group as a whole but did significantly enhance TBC in 6 patients who expectorated during both placebo and IPG 6-h observation periods. In 4 patients who did not expectorate in either period no change in TBC occurred. In 10 patients who expectorated in either one or both observation periods, a significant positive correlation was found between an index of the patients' sputum produced and improvement in TBC following IPG treatment. IPG can be an effective expectorant in patients with mucus hypersecretion and particularly so in patients with copious sputum production.

Aged↗
PubMed1984

Clinical effects of proteinase, sfericase (AI-794), on chronic bronchitis and similar diseases.

The clinical effect and utility of sfericase was compared with an inactive placebo by a double-blind method in three groups of a total 109 patients suffering from chronic respiratory diseases who had complained of difficult expectoration of sputum. A significantly greater improvement of expectoration was obtained in Group A-1 (6 tablets/day). Also in group A-1, more cases showed subjective and objective improvement, i.e., improvement in expectoration, reduction in coughs, decrease in the amount of sputum, and disappearance of râles. However, the sputum and its degree of purulency remained unchanged in most cases in all three groups. Side effects were few. The clinical efficacy of sfericase in the group with 2 tablets, 3X/day (total daily dose of 6 tablets) was shown to be significantly superior to the other two groups. This dosage was established as the optimal dose for treating difficulty in expectoration.

Adult↗
PubMed1993

Sputum quality: can you tell by looking?

BACKGROUND: Nurses are responsible for the collection of sputum samples for culture in most institutions, yet they receive little formal training on what a good specimen looks like. METHODS: Three hundred thirty-three consecutively collected expectorated sputum samples and tracheal aspirates were examined to determine the relationship of macroscopic specimen appearance (watery, mucoid, mucopurulent) to specimen quality (good, fair, poor). RESULTS: Of the expectorated sputum samples, 21% were watery, 65% were mucoid, and 14% were mucopurulent. Sixty-five percent of the expectorated sputum samples were good or fair, regardless of appearance. Eighty-seven percent of mucopurulent expectorated sputum samples were good or fair. In the remaining nonmucopurulent specimens, however, there were no predictable markers of specimen quality. CONCLUSIONS: The only specimens that were predictably good were those that were mucopurulent yellow, yellow, or tracheal aspirates.

Humans↗
PubMed1994

Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis.

The Flutter is a handheld device designed to facilitate clearance of mucus in hypersecretory lung disorders. Exhalation through the Flutter results in oscillations of expiratory pressure and airflow, which vibrate the airway walls (loosening mucus), decrease the collapsibility of the airways, and accelerate airflow, facilitating movement of mucus up the airways. We studied 18 patients with cystic fibrosis and mild to moderate lung disease to determine the efficacy of the Flutter in clearing mucus from the airways. The amount of sputum expectorated (measured by weight) when the Flutter was used was compared with the amount expectorated with vigorous voluntary coughing and with postural drainage (chest percussion and vibration). The amount of sputum expectorated by subjects using the Flutter was more than three times the amount expectorated with either voluntary cough or postural drainage (p < 0.001). There were no adverse effects. The Flutter is simple to use, inexpensive, and fully portable, and once the patient and family are instructed in its use, it does not require the assistance of a caregiver. For hospitalized patients, elimination of the need for a therapist could reduce health care costs. Long-term studies of the use of the Flutter seem justified to determine its effects on pulmonary function and outcome.

Adolescent↗
PubMed2002

Preventing nosocomial transmission of pulmonary tuberculosis: when may isolation be discontinued for patients with suspected tuberculosis?

OBJECTIVE: The Centers for Disease Control and Prevention and the American Thoracic Society recommend obtaining cultures of at least three sputum specimens for acid-fast bacilli (AFB) from patients in whom tuberculosis (TB) is suspected. On the basis of this, most hospitals isolate patients with suspected TB for 3 days or more until three smear (not culture) results are negative. Our objective was to evaluate the predictive value and sensitivity of these smears. DESIGN: Observational study. SETTING: Four urban medical centers. METHODS: The posttest probability of TB given sequential negative AFB smears from 274 patients isolated for suspected TB and the sensitivity of sequential AFB smears from 209 patients with positive results on culture for pulmonary TB were measured. RESULTS: The posttest probabilities of having TB given one, two, and three negative AFB smears were low: 1.1% (3 of 265; 95% confidence interval [CI95], 0.23% to 3.27%), 0.4% (1 of 262; CI95 0% to 2.1%), and 0% (0 of 260; CI95, 0% to 1.4%), respectively. Among the 209 patients with positive results on culture for pulmonary TB, 169 (81%) had an expectorated sputum specimen sent, of which 91 (54%) were positive for AFB. Forty (24%) of the 169 patients had a second expectorated sputum specimen sent after the results of the first specimen were negative; only 6 (15%) of these had positive AFB smears. None of the 10 patients in whom the first two expectorated sputum samples yielded an AFB smear without an organism had a third AFB smear that was positive. CONCLUSION: Unless there is high clinical suspicion of pulmonary TB in a specific patient, the use of three AFB smears on expectorated sputa is a rational approach to discontinuing isolation for patients with suspected TB.

Baltimore↗
PubMed1998

The pattern of micro-organisms and the efficacy of new macrolide in acute lower respiratory tract infections.

Lower respiratory tract infection (LRTI) is one of the major health problems in developing countries such as Indonesia. According to the National Household Health Survey conducted by the Ministry of Health in 1992, LRTIs still rank fourth as the main cause of death in Indonesia. The problem of LRTIs could be simply managed as long as the causative organism can be identified and the proper antibiotic known. In some occasions, it is not quite so easy to identify the causative micro-organism, especially in lower tract infections. There are several methods of obtaining specimens from LRTIs for cultures. The easiest, most simple way is to collect expectorated sputum. Unfortunately, because of the high rate of contamination by upper respiratory tract flora, this method is not reliable. Recognizing the difficulties with routine expectorated sputum cultures, two alternative approaches have been suggested. One approach is to bypass potential expectorated sputum 'contaminants' in the oropharynx by transtracheal aspiration or transthoracic aspiration. The second approach is to modify the usual technique of processing expectorated sputum by either washing techniques or by quantitative cultures. Azithromycin and clarithromycin are chemically related to macrolide erithromycin. Both antibiotics retain the traditional macrolide spectrum of activity against gram-positive and atypical pneumonia pathogens, while demonstrating improved activity against gram-negative bacteria. The American Thoracic Society (ATS) recommended the use of macrolide for outpatients with community-acquired pneumonia, without comorbidity and 60 years of age or younger. A total of 34 outpatients with acute LRTIs were open-comparative, randomly allocated to treatment with the new macrolide in Persahabatan Hospital, Jakarta, 1996. The purposes of this study were: (i) to identify the causative micro-organisms; and (ii) to evaluate the clinical efficacy of the new macrolide in these infections. Azithromycin 500 mg was given orally once a day for 3 days and was administered 1 h before or 2 h after every meal. Clarithromycin 500 mg was given orally every 12 h for 10 days. The diagnosis of the patients were: 16 with pneumonia, 10 with acute bronchitis and 8 with acute exacerbation of chronic bronchitis. In this study of 34 patients, the sputum specimens were washed with N acetylcysteine before culture and we could only detect micro-organisms in one patient. Before treatment, we found 47 strains in 33 (97.05%) patients and after treatment we found five strains. From serological examination, only four (11.76%) atypical bacterial were detected. The most frequently found microorganisms were 23 strains of Klebsiella pneumoniae (40.42%), 10 of Streptococcus alpha haemolyticus (21.26%), five of Streptococcus pneumoniae (10.63%) and five of Staphylococcus aureus (10.63%). The atypical bacterial were: two Legionella pneumophila, one Mycoplasma pneumoniae and one Chlamydia pneumoniae. The clinical efficacy of new macrolides were 100% and the bacteriological responses with eradication of 94.12% vs 70.59% of isolates in the azithromycin and clarithromycin groups are shown in Table 1. There were no adverse reactions detected in the two treatment groups until the end of the study.

Administration, Oral↗
PubMed1998

Clinical efficacy of the FLUTTER device for airway mucus clearance in patients with diffuse panbronchiolitis.

Expectoration of mucus is important in preventing the development of airway inflammation in patients with diffuse panbronchiolitis (DPB). To evaluate the clinical efficacy of the FLUTTER device in clearing mucus from the airways of patients with DPB who have difficulty expectorating, we assessed pulmonary function and symptoms in patients treated with FLUTTER. Eight patients in a stable clinical condition with DPB were included in the study. The study was divided into two consecutive, 1-week periods. The initial week was an observation week. During the following week, patients used FLUTTER four times daily. Expectorated sputum was collected in a container and weighed every day during 2 weeks. Pulmonary function, partial oxygen pressure and partial carbon dioxide pressure in arterial blood were measured in all patients on the last day of the observation week and the FLUTTER treatment week. A symptom score for difficulty of expectoration was determined by questionnaire. A pneumothorax developed in one patient during using FLUTTER. The mean daily sputum weight and peak expiratory flow rate increased significantly after treatment with FLUTTER ( P< 0.04 and P< 0.02, respectively). Symptom score improved significantly after using FLUTTER ( P< 0.02). We conclude that the use of FLUTTER is effective in clearing mucus from the airways. However, the development of a pneumothorax may complicate use of the procedure in some cases.

Adult↗
PubMed1984

Oral fluoride retention with thixotropic and APF gels and foam-lined and unlined trays.

Ten child volunteers each received four topical fluoride applications using different techniques. The amounts of fluoride applied, recovered from the mouth, and retained in the mouth were calculated for each treatment. The value of patient expectoration following topical F treatment was also evaluated. The tray system with an absorptive liner significantly reduced the amount of gross oral-retained fluoride (p less than 0.01). Expectoration following topical treatment with either an APF or thixotropic gel was a significant adjunct in reducing the net oral-retained F dose (p less than 0.01). When expectoration is done following a topical F treatment, a thixotropic gel may be an added advantage in reducing oral F retention and ingestion. We recommend that suction devices be used during a topical F treatment, but most importantly that the patient be requested to expectorate thoroughly following topical treatment.

Acidulated Phosphate Fluoride↗
PubMed1987

Clinical application of topical fluoride products--risks, benefits, and recommendations.

This portion of the symposium discusses the various methods of professionally applying high-concentration topical fluoride products and their risks and benefits. Numerous recent investigations in this area of research are reviewed and discussed. Data from these research investigations point to the need for care when high-potency F products are used, especially in young children. Oral-retained F doses following four-minute topical application procedures ranged from 10 to 31 mg when no suction devices or patient expectoration was utilized. Following the use of suctioning devices, oral-retained F doses ranged from 6 to 12 mg, a clinically unacceptable level. Following the use of suctioning devices plus patient expectoration, the oral-retained F doses were reduced to from 2 to 7.5 mg, depending on type of F product and application system. The following recommendation for topical application of high-potency F products are made: (1) No more than 2 g of gel per tray or approximately 40% of tray capacity should be dispensed. Even more conservative amounts should be considered for small children. (2) Because patients may have the need to swallow during a four-minute topical application procedure, the use of a saliva ejector during the procedure is recommended. (3) Following the four-minute application procedure, the patient should be instructed to expectorate thoroughly for from 30 sec to one min, regardless of whether high-speed suction is utilized. Expectoration is probably the single most effective way of reducing orally retained fluoride. (4) When utilizing custom individually fitted trays for patients requiring daily or weekly application of a high-F-concentration product, utilize only 5 to 10 drops of product per tray.

Absorption↗
PubMed1996

Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination.

Sputum examination is being used increasingly as a noninvasive method to assess airway inflammation. Expectorated sputum has variable contamination with saliva. Methods of processing have included the selection of portions of the sample considered to be representative of pulmonary origin versus use of the whole specimen, which is confounded by varying volumes of saliva. We compared cell profiles and eosinophilic cationic protein (ECP) concentration in sputum selected from the expectorate and in the usually discarded residual portion to determine to what degree salivary contamination is minimized and if the results are representative of lower respiratory secretions. Sputum was induced with hypertonic saline in six healthy and nine asthmatic subjects. All portions considered to be of pure lower respiratory tract origin were selected from the residual. The selected and residual portions were treated with dithiothreitol, total cell counts and cell viability were obtained, cytospins were made for differential cell counts and supernatant was collected for ECP assay. Selected portions of the specimens, in comparison with the residual portion showed: little squamous cell contamination (median 1.2 vs 70%; p < 0.001); higher total cell counts.mL-1 (5.1 vs 0.5 x 10(6) cells.mL-1; p < 0.001); higher number of viable nonsquamous cells per sample (1.9 vs 0.6 x 10(6) cells; p < 0.001); higher slide quality score (7 vs 4; p < 0.001); and higher levels of ECP (768 vs 136 micrograms.L-1; p < 0.001). There were no differences in the differential cell counts of eosinophils (1.3 vs 3.8%), neutrophils (44 vs 32%), and lymphocytes (0.6 vs 0.6%). While the proportion of macrophages was lower (36 vs 54%; p < 0.05), the absolute number (41 vs 19 x 10(4) cells; p < 0.05) was higher in the selected portion. In summary, selection of all portions of induced sputum from the expectorate minimized the confounding influence of saliva. Loss of nonsquamous cells in the residual portion was variable but usually less than one third of those in the selected portion. With one exception, this loss had little influence on the differential counts of inflammatory cells. Similar observations apply to eosinophilic cationic protein levels. We conclude that, in healthy subjects and treated asthmatics, inflammatory markers in the selected portion of the expectorate can be used to represent those in the lower respiratory tract in general.

Adult↗