Induced Sputum in Patients With Newly Diagnosed Sarcoidosis

D’Ippolito, Raffaele; Foresi, Antonio; Chetta, Alfredo; Casalini, Angelo Gianni; Castagnaro, Antonio; Leone, Clementina; Olivieri, Dario

doi:10.1378/chest.115.6.1611

Cited by 48 publications

(58 citation statements)

References 16 publications

(23 reference statements)

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“…Results of several recent publications support the notion that collection of spontaneously expectorated and induced sputum may provide a viable alternative to bronchoscopy and BAL for assessing immune function in the lung, both in healthy individuals and in patients with lung disease (3,7,8,14). Induced sputum, in particular, may provide information qualitatively similar to that obtained from BAL (7,8,11,17).…”

Section: Discussionmentioning

confidence: 71%

“…Even though induced sputum is favored over spontaneous sputum by some investigators for study of lower airway inflammation, since it may better resemble findings in BAL (3,7), others have shown that total cell differential and cytokine content are comparable in induced and spontaneous sputum and BAL (7,11). To investigate whether sputum specimens also could be used to study immune parameters at sites of active TB, we collected spontaneous and induced sputum and serum from patients with newly diagnosed pulmonary TB in Vitória, Brazil, serially throughout the first 12 weeks of antituberculous chemotherapy.…”

mentioning

confidence: 99%

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Sputum Cytokine Levels in Patients with Pulmonary Tuberculosis as Early Markers of Mycobacterial Clearance

Ribeiro‐Rodrigues

Có

Johnson

et al. 2002

Clin Vaccine Immunol

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Sputum and serum from patients with active pulmonary tuberculosis (TB), healthy purified protein derivative-positive adults, and patients with bacterial pneumonia were collected to simultaneously assess local immunity in the lungs and peripheral blood. To determine whether cytokine profiles in sputum from TB patients and control subjects were a reflection of its cellular composition, cytospin slides were prepared in parallel and assessed for the presence of relative proportions of epithelial cells, neutrophils, macrophages, and T cells. Gamma interferon (IFN-␥) in sputum from TB patients was markedly elevated over levels for both control groups. With anti-TB therapy, IFN-␥ levels in sputum from TB patients decreased rapidly and by week 4 of treatment were comparable to those in sputum from controls. Further, IFN-␥ levels in sputum closely followed mycobacterial clearance. Although detected at fourfold-lower levels, IFN-␥ immunoreactivities in serum followed kinetics in sputum. TNF-␣, interleukin 8 (IL-8) and IL-6 also were readily detected in sputum from TB patients at baseline and responded to anti-TB therapy. In contrast to IFN-␥, however, TNF-␣ and IL-8 levels also were elevated in sputum from pneumonia controls. These data indicate that sputum cytokines correlate with disease activity during active TB of the lung and may serve as potential early markers for sputum conversion and response to anti-TB therapy.Despite efforts to improve diagnosis and treatment, tuberculosis (TB) remains a major health problem worldwide, especially in developing countries. Obstacles to TB control include the long duration of therapy and the lack of concrete markers indicating success or failure of treatment early during the course of active disease.Sputum culture conversion following 8 weeks of treatment has been used as a surrogate of response to antituberculous chemotherapy (16). However, cultures require up to 6 weeks to perform and, therefore, are not ideally suited for real-time assessment of response to treatment. By contrast, assessment of immunological parameters in biological fluids can be accomplished within days of sample collection and, if validated as a surrogate marker, may be particularly useful in settings where the activity of short-term administration of new drugs (early bactericidal activity studies) or of immunoadjuvants to standard anti-TB therapy is tested. Further, identifying immunological parameters that correlate with culture sterilization may provide important information about host factors most relevant to anti-Mycobacterium tuberculosis (MTB) immunity.Since TB predominantly affects the lung, assessment of specimens recovered from this site may best reflect the interaction between the host and MTB during active disease. Fiber optic bronchoscopy and bronchoalveolar lavage (BAL) has been used to assess anti-MTB immunity in situ (18,19). However, this invasive technique cannot be applied serially during treatment. As a result we investigated alternative approaches for evaluating anti-MTB immune responses ...

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Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

Sputum Cytokine Levels in Patients with Pulmonary Tuberculosis as Early Markers of Mycobacterial Clearance

Ribeiro‐Rodrigues

Có

Johnson

et al. 2002

Clin Vaccine Immunol

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“…BAL was carried out as previously described [20]. The bronchoscope was wedged into a segment of the right middle lobe, and three 50-mL aliquots of sterile saline solution, warmed to 37°C, were instilled into the subsegmental bronchus.…”

Section: Bronchoscopy Proceduresmentioning

confidence: 99%

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

D’Ippolito

Foresi²,

Castagnetti

et al. 2016

Monaldi Arch Chest Dis

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Aim. To evaluate the indications and the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL), protected specimen brushing (PSB), endobronchial biopsy (EBB), and transbronchial biopsy (TBB) in a population of very elderly patients. Methods. We performed a retrospective study of all adult patients, aged 50 years or older, who underwent FOB in the Bronchology Unit of the University of Parma Hospital between 1 January, 2003 and 31 April, 2005. Bronchoscopy records of 436 consecutive patients, including 191 patients, 75 yrs of age and older (“very elderly”; =>75 yrs), were reviewed. Results. Patients aged 75 years were no different with regard to gender, BMI, baseline FEV1/FVC ratio, baseline SaO2, and blood pressure. The primary indication in patients aged <75 years, was to assist in the diagnosis of a pulmonary mass of unknown aetiology (33%) and to remove secretions in the very elderly patients (31%). Indications for FOB and sampling procedures in the two groups were similar. Approximately 30% of patients in each group required supplemental oxygen during the procedure and fever occurred in 9.2% and 10.3% of patients, respectively.Hypertension and bleeding were relatively rare and did not occur more often in the very elderly. Conclusions. Indication for FOB did not vary with age and adverse events in both groups were uncommon and generally not severe.

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“…3e) [76]. In untreated patients with newly diagnosed stage I and II sarcoidosis compared with normal subjects, induced sputum examination was shown to be an alternative to bronchoscopy with bronchial washings or BAL to demonstrate a lymphocytosis [78]. Induced sputum examination was initially introduced to diagnose lung malignancy, but this use has now chiefly been taken over by bronchoscopy.…”

Section: Other Cellular Abnormalitiesmentioning

confidence: 99%

Induced sputum cell counts: their usefulness in clinical practice

et al. 2000

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Airway inflammation is fundamental to the aetiology and persistence of asthma and other airway conditions. The presence and type of airway inflammation can be difficult to detect clinically, delaying the introduction of appropriate treatment. Induced sputum cell counts are a relatively noninvasive, safe and reliable method of identifying airway inflammation. They can accurately discriminate eosinophilic airway inflammation from noneosinophilic airway inflammation, and help guide therapy. Eosinophilic airway inflammation is steroid responsive whilst noneosinophilic (usually neutrophilic) inflammation generally is not. Macrophages containing haemosiderin can be useful in detecting left ventricular dysfunction and macrophages containing lipid are suggestive of oropharyngeal reflux with microaspiration, both of which can complicate or confuse assessment of airway disease. To date, studies using induced sputum are primarily observational. Management studies based on examination of induced sputum are now needed to validate the clinical utility of this test.

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Induced Sputum in Patients With Newly Diagnosed Sarcoidosis

Cited by 48 publications

References 16 publications

Sputum Cytokine Levels in Patients with Pulmonary Tuberculosis as Early Markers of Mycobacterial Clearance

Sputum Cytokine Levels in Patients with Pulmonary Tuberculosis as Early Markers of Mycobacterial Clearance

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

Induced sputum cell counts: their usefulness in clinical practice

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