Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements.

Pizzichini, Emílio; Pizzichini, Márcia Margaret Menezes; Efthimiadis, A.; Evans, S. A.; Morris, Marilyn M.; Squillace, Diane L.; Gleich, Gerald J.; Dolovich, J.; Hargreave, Frederick E.

doi:10.1164/ajrccm.154.2.8756799

Cited by 883 publications

(828 citation statements)

References 23 publications

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“…Post-bronchodilator FEV1 was recorded. Sputum was induced by hypertonic saline according to the method described by PIZZICHINI et al [11] with slight modifications. Sputum was selected from saliva, its colour was recorded and it was processed within 2 h as described by PIZZICHINI et al [22].…”

Section: Clinical Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Parameswaran

Pizzichini

et al. 2000

Eur Respir J

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The inflammatory component of asthma is usually assessed indirectly by symptoms and spirometry, these may be inaccurate. It can now be assessed directly and reliably by the examination of sputum cell counts. There is no information on how clinical assessment of the presence and type of airway inflammation compares with actual measurements.In this single-centre observational study, sputum was collected from 76 consecutive adults with asthma attending a tertiary chest clinic after their physicians had recorded the expected cell counts in sputum. The authors examined the extent of agreement between clinical judgement of sputum cell counts and actual counts in asthmatic patients (Cohen's Kappa) and the possible predictors of agreement (multiple logistic regression).Sixty-seven of the 76 sputum samples were suitable for analysis. Agreement between expected and actual cell counts occurred in 30/67 patients. The overall agreement for the different cell types was poor (estimated k=0.14, 95% confidence interval (CI)=0.02, 0.26). The experience of the physician in using sputum cell counts in clinical practice, steroid requirement at the time of assessment, and control of asthma as assessed by the physician or by the patient could not predict the chances of agreement or disagreement. Unaware of the sputum results, the physicians often changed treatment in a way that seemed inappropriate for the cell counts present.There is poor agreement between clinical judgement of the presence and type of airway inflammation in asthmatic patients and sputum cell counts. The impact of sputum examination on the outcomes of anti-inflammatory treatment now needs investigation. Eur Respir J 2000; 15: 486±490.

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Section: Clinical Methodsmentioning

confidence: 99%

“…At least 400 intact nonsquamous cells were counted on one stained cytospin. Significant eosinophilia was defined as >3% and a neutrophilia consistent with infection as >80% [9,11,23].…”

Section: Clinical Methodsmentioning

confidence: 99%

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Parameswaran

Pizzichini

et al. 2000

Eur Respir J

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“…Sputum was induced with hypertonic saline, and then separated from saliva and processed within 2 h; cell counts were determined as previously described [16]. Cytospins were prepared and stained with oil red O (Sigma-Aldrich Canada Ltd, Oakville, Ontario, Canada) to detect cytoplasmic lipid droplets.…”

Section: Methodsmentioning

confidence: 99%

“…Demonstration of lipid in alveolar macrophages may be an indicator of aspiration of acidic gastric contents [10], and cytological examination of bronchoalveolar lavage fluid for lipid-laden macrophages has been suggested as a useful diagnostic test for aspiration [11±15]. Determination of cell counts in induced sputum separated from saliva is a reliable noninvasive method of assessing airway inflammation [16], and the use of an index of macrophages in sputum staining positive for intracellular lipid has been reported [17]. In previous studies there have been two difficulties, the lack of a "gold standard" for the diagnosis of aspiration and the inclusion of patients with a variety of chronic respiratory diseases [18].…”

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confidence: 99%

Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration

Parameswaran¹,

Anvari²,

Efthimiadis³

et al. 2000

Eur Respir J

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The diagnostic properties of a "lipid index" of macrophages in induced sputum as a noninvasive marker of aspiration of acidic gastric contents were evaluated.In a cross-sectional study, 33 subjects (17 with symptoms suggestive of gastrooesophageal reflux) with normal chest radiographs and no symptoms of aspiration or sinus disease, underwent dual-channel 24-h ambulatory oesophageal pH recording and sputum induction. Oropharyngeal reflux, defined as at least one episode of a fall in pH to <4 at the upper oesophageal electrode, was considered indicative of aspiration of acidic gastric contents ("gold standard"). An index for the presence of intracellular lipid in sputum macrophages, detected by oil red O stain, was obtained. The sensitivity, specificity and predictive values of this "lipid index" were calculated.The "lipid index" could be calculated in 29 of 33 samples with high interobserver repeatability (intraclass correlation coefficient 0.96). Twenty subjects showed oropharyngeal reflux and nine did not. The median "lipid index" in subjects with oropharyngeal reflux (24.5) was significantly greater than that in those without reflux (1.0) (p<0.001). A "lipid index" of 7.0 had a sensitivity of 90%, a specificity of 89%, a positive predictive value of 95% and a negative predictive value of 80%.A "lipid index" of 7.0 in the macrophages of induced sputum is a good marker of oropharyngeal reflux.

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“…Sputum was induced and processed as previously described [12,13]. Briefly sputum was induced using 3, 4 and 5% saline inhaled in sequence for 5 min via an ultrasonic nebulizer (Medix, Harlow, Essex, UK; output 0.9 mL .…”

Section: Measurementsmentioning

confidence: 99%

Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis

et al. 2000

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Eosinophilic bronchitis is a common cause of chronic cough, characterized by sputum eosinophilia similar to that seen in asthma, but unlike asthma the patients have no objective evidence of variable airflow obstruction or airway hyperresponsiveness. The reason for the different functional associations is unclear. The authors have tested the hypothesis that in eosinophilic bronchitis the inflammation is mainly localized in the upper airway.In an open study the authors measured the lower (provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20)) and upper (PC25 MIF50) airway responsiveness to histamine, lower and upper airway inflammation using induced sputum and nasal lavage, in 11 patients with eosinophilic bronchitis. The authors assessed changes in these measures and in cough reflex sensitivity to capsaicin and cough severity after 400 mg of inhaled budesonide for 4 weeks.A nasal eosinophilia was present in only three patients with one having upper airway hyperresponsiveness. Following treatment with inhaled corticosteroids the geometric mean sputum eosinophil count decreased from 12.8% to 2.9% (mean difference 4.4-fold, 95% confidence interval (CI) 2.14±10.02), the mean SEM cough visual analogue score on a 100 mm scale decreased from 27.2 6.6 mm to 12.6 5.7 mm (mean difference 14.6, 95% CI 9.1±20.1) and the cough sensitivity assessed as the capsaicin concentration required to cause two coughs (C 2 ) and five coughs (C 5 ) improved (C 2 mean difference 0.75 doubling concentrations, 95% CI 0.36±1.1; C 5 mean difference 1.3 doubling concentration, 95% CI 0.6±2.1). There was a significant positive correlation between the fold change in sputum eosinophil count and doubling dose change in C 5 after inhaled budesonide (r=0.61).It is concluded that upper airway inflammation is not prominent in eosinophilic bronchitis and that inhaled budesonide improves the sputum eosinophilia, cough severity and sensitivity suggesting a causal link between the inflammation and cough. Eur Respir J 2000; 15: 682±686.

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Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements.

Cited by 883 publications

References 23 publications

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration

Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis

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