Spontaneous and induced sputum to measure indices of airway inflammation in asthma.

Pizzichini, Márcia Margaret Menezes; Popov, Todor A.; Efthimiadis, A.; Hussack, P; Evans, S. A.; Pizzichini, Emílio; Dolovich, J.; Fe, Hargreave

doi:10.1164/ajrccm.154.4.8887576

Cited by 207 publications

(149 citation statements)

References 16 publications

(7 reference statements)

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“…Subjects unable to produce an adequate sample (at least 7 ϫ 10 5 cells with у 70% nonepithelial cells) were excluded from the study. Sputum was processed on ice using the "plug selection" technique (13). Induced sputum samples were tested for cell count and differential by light microscopy.…”

Section: Sputum Inductionmentioning

confidence: 99%

Comparing Inhaled Ultrafine versus Fine Zinc Oxide Particles in Healthy Adults

Beckett

Chalupa

Pauly-Brown

et al. 2005

Am J Respir Crit Care Med

146

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Rationale: Zinc oxide is a common, biologically active constituent of particulate air pollution as well as a workplace toxin. Ultrafine particles (Ͻ 0.1 m diameter) are believed to be more potent than an equal mass of inhaled accumulation mode particles (0.1-1.0 m diameter). Objectives: We compared exposure-response relationships for respiratory, hematologic, and cardiovascular endpoints between ultrafine and accumulation mode zinc oxide particles. Methods: In a human inhalation study, 12 healthy adults inhaled 500 g/m 3 of ultrafine zinc oxide, the same mass of fine zinc oxide, and filtered air while at rest for 2 hours. Measurements and Main Results: Preexposure and follow-up studies of symptoms, leukocyte surface markers, hemostasis, and cardiac electrophysiology were conducted to 24 hours post-exposure. Induced sputum was sampled 24 hours after exposure. No differences were detected between any of the three exposure conditions at this level of exposure. Conclusions: Freshly generated zinc oxide in the fine or ultrafine fractions inhaled by healthy subjects at rest at a concentration of 500 g/m 3 for 2 hours is below the threshold for acute systemic effects as detected by these endpoints.Keywords: air pollution; metal fume fever; particulate matter, ultrafine; zinc Ambient air pollution particles occur in three major size distributions. Common combustion processes generate some primary ultrafine particles (Ͻ 0.1 m diameter), which can rapidly coalesce into larger accumulation mode particles (0.1-1.0 m diameter). The third fraction is the coarse mode particles, from 1 to 100 m in diameter, which are often generated by mechanical breakdown of the earth's crustal minerals. A given mass of ultrafine particles has a markedly higher ratio of total surface area to weight than does the same mass of accumulation mode particles. In experimental animals, inhaled ultrafine particles exhibit greater lung inflammatory and systemic activity than an equal mass of larger particles, and these particles may also have greater effects in adult human subjects (1-3). With ambient particle air pollution exposure, certain respiratory effects have been more closely associated with the number of ultrafine particles than with the total mass of particle exposure (4).Zinc is a common element in the earth's crust and an essential mineral in human nutrition. Zinc oxide may be found in ambient air particles from combustion sources (5-7), and it is generated in high concentrations in industrial processes, such as brass founding and welding or cutting galvanized sheet metal. Actual exposures of welders and others depend on the conditions in the workplace, but the permissible exposure limit for occupational exposure to zinc oxide in the United States is 5.0 mg/m 3 respirable dust. Zinc is one of several transition metals that have been proposed to contribute to the biological activity of ambient combustion particles. Freshly generated zinc oxide causes a selflimited, febrile, and inflammatory response known as metal fume fever, subtle findings ...

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Section: Sputum Inductionmentioning

confidence: 99%

Comparing Inhaled Ultrafine versus Fine Zinc Oxide Particles in Healthy Adults

Beckett

Chalupa

Pauly-Brown

et al. 2005

Am J Respir Crit Care Med

146

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“…After each nebulization, the patients were requested to wipe their noses and rinse their mouths with water in order to avoid contamination with saliva and then cough and spit into the pot. 10 The pot containing the sputum was kept in a polystyrene box with ice and processed within 2 hours of collection. All procedures were followed by one of the researching doctors who was available at the laboratory, in case material or medication became urgently necessary.…”

Section: Sputum Induction and Processingmentioning

confidence: 99%

Escarro induzido em crianças e adolescentes com asma: segurança, aplicabilidade clínica e perfil de células inflamatórias em pacientes estáveis e durante exacerbação

Palomino¹,

Bussamra²,

Saraiva-Romanholo³

et al. 2005

J. Pediatr. (Rio J.)

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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 FEV 1 , 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.

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“…The patients rated their over-all asthma symptoms as either feeling at their best or worse than their best. Spontaneous or, if this was not possible, induced sputum was collected and cell counts were made blind to the clinical details; these have been shown to give similar cell counts [19].…”

Section: Designmentioning

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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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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Spontaneous and induced sputum to measure indices of airway inflammation in asthma.

Cited by 207 publications

References 16 publications

Comparing Inhaled Ultrafine versus Fine Zinc Oxide Particles in Healthy Adults

Comparing Inhaled Ultrafine versus Fine Zinc Oxide Particles in Healthy Adults

Escarro induzido em crianças e adolescentes com asma: segurança, aplicabilidade clínica e perfil de células inflamatórias em pacientes estáveis e durante exacerbação

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

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