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Induced sputum testing is a non-invasive test that reflects the nature and extent of airway inflammation and plays an important role in the diagnosis, treatment and prognosis of chronic airway diseases. This article outlines the development history of induced sputum technology, introduces the principle and operation of induced sputum technology, evaluates its safety, summarizes the three main test components, elaborates the role of this technology in various chronic airway diseases, such as reflecting the type of airway inflammation, predicting the efficacy of medication, and combining it with transcriptomics to study disease mechanisms, and briefly summarizes its innovations and makes a vision for the future.
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AIM: To observe the effect of fudosteine on induced sputum cell components and lung function in patients with stable neutrophil-dominated COPD. METHODS: From October 2019 to October 2022, 53 patients with stable COPD were selected and divided into fudosteine group and placebo group. The placebo group was treated with routine treatment, and the fudosteine group was treated with fudosteine on the basis of routine treatment. The two groups were treated for 6 months. The clinical symptoms [Saint George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and Modified British Medical Research Council Dyspnea scale (MMRC), Breathlessness, Cough, and Sputum Scale (BCSS)], lung function index, induced sputum cytology analysis and other related examination results were recorded in detail before and after treatment. RESULTS: (1) Compared with the baseline, the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and the ratio of FEV1 to FVC (FEV1/FVC) of the two groups were improved after treatment, and the differences were statistically significant (P<0.05). However, after treatment, there was no significant difference in pulmonary function between the two groups except for the percentage of carbon monoxide diffusion in the predicted value (DLCO%pre) (DLCO%pre in the fudosteine group was higher than that in the placebo group). (2) After treatment, the total number of induced sputum cells and neutrophil counts in the fudosteine group were lower than those in the placebo group. Compared with the number of cells in each component at baseline, the total number of induced sputum cells and neutrophil count in the fudosteine group were significantly lower (P< 0.05). CONCLUSION: Fudosteine treatment in patients with stable neutrophil-dominated COPD can improve lung function, reduce the total number of induced sputum cells and the total number of neutrophils, thereby improving airway inflammation.
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ObjectiveTo investigate effect of Maxing Shigantang and supplemented Guominjian decoction on symptoms and levels of inflammatory cytokines in induced sputum of children with cough variant asthma （CVA）. MethodA total of 118 CVA children who were treated in our hospital from January 2020 to January 2021 were enrolled and randomized into the control group and the observation group with the random number table method. Control group received routine western medicine and the observation group was treated by routine western medicine， Maxing Shigantang， and supplemented Guominjian decoction. In the one-month follow-up， the scores of cough and accompanying symptoms， levels of inflammatory cytokines ［interleukin-10 （IL-10）， interleukin-5 （IL-5）， tumor necrosis factor-α （TNF-α）， neutrophil， eosinophil］ in induced sputum， pulmonary function parameters ［forced vital capacity （FVC）， forced expiratory volume in one second （FEV1）， FEV1/FVC］， and treatment outcomes were compared between the two groups. Moreover， the frequency of acute asthma attacks during the three-month follow-up was also compared. ResultNo cases dropped out from this study. After treatment， the scores of cough and accompanying symptoms were decreased in both groups （P<0.05） and were lower in observation group than in control group （P<0.05）. After treatment， FVC， FEV1， and FEV1/FVC were raised in both groups and were higher in observation group than in control group （P<0.05）. The increase in the level of IL-10 along with the decrease in levels of IL-5， TNF-α， neutrophil， and eosinophil in induced sputum was found in both groups after treatment （P<0.05）， and observation group had higher level of IL-10 and lower levels of IL-5， TNF-α， neutrophil， and eosinophil than the control group （P<0.05）. The effective rate was 86.44% （51/59） in observation group， which was higher than the 69.49% （41/59） in control group （χ2=4.933， P<0.05）. No serious adverse reaction occurred in either group. The frequency of acute asthma attacks during the three-month follow-up was （1.09±0.18） in observation group， which was lower than the （2.83±049） in the control group （P<0.05）. ConclusionRoutine western medicine combined with Maxing Shigantang and supplemented Guominjian decoction can effectively and safely alleviate the airway inflammatory responses， control the clinical symptoms， improve pulmonary function， and reduce the frequency of acute recurrence in the treatment of CVA children.
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Las enfermedades broncopulmonares se asocian a diversos mecanismos inflamatorios de las vías aéreas. Evaluar y comprender el perfil inflamatorio de estos pacientes podría contribuir a conocer la etiología y así optimizar el tratamiento. El esputo inducido es una técnica mínimamente invasiva, por lo que su implementación resulta de interés en la práctica habitual. Aunque el estudio del esputo inducido ha demostrado utilidad y seguridad, los centros que desarrollan esta técnica en la Argentina son escasos. Con el objetivo de estandarizar el procedimiento de recolección y análisis de muestras de esputo inducido en pacientes con enfermedades inflamatorias broncopulmonares, se desarrolló esta guía consensuada por los centros con experiencia en esta técnica en nuestro país. Es nuestra intención difundir esta técnica, mínimamente invasiva, para su aplicación en servicios especializados. Esta guía de procedimientos detalla los materiales que son requeridos, los métodos y los estándares de calidad y seguridad tanto para los pacientes como para los operadores.
Bronchopulmonary diseases are associated with different inflammatory mechanisms of the airways. Assessing and understanding the inflammatory profile of these patients could contribute to the understanding of the etiology and thus optimize the treatment. Induced sputum is a minimally invasive technique, so its implementation is of interest in the usual practice. Although the studies of induced sputum have shown usefulness and safety, the centers that develop this technique in Argentina are scarce. With the aim of standardizing the procedure that includes the collection and analysis of induced sputum samples in patients with bronchopulmonary inflammatory diseases, some centers in our country with experience in this technique achieved a consensus on the development of this Guide. It is our intention to disseminate this minimally invasive technique for its application in specialized services. This procedure guide details the necessary materials and methods and quality and safety standards for both patients and operators.
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Sputum , Reference Standards , Asthma , Bronchial Diseases , ConsensusABSTRACT
Objective:To explore the clinical effect of the application of modified Dingchuantang in the treatment of children with cough variant asthma (CVA). Method:Totally 142 children with CVA admitted by our hospital from June 2016 to June 2018 were selected and randomly divided into observation group (71 cases) and control group (71 cases) according to the random number table method. Patients in control group were treated with inhaled budesonide powder inhalation+oral montelukast sodium chewable tablets, while patients in observation group were treated with modified Dingchuantang. All children were treated for 8 weeks. The two groups' clinical effects, changes of levels of airway function parameters[percentage of forced expiratory volume in the first second (FEV1%) and expiratory flow rate of forced expiratory in 50% and 75% vital capacity (FEF50, FEF75)], sputum induction indexes[nerve growth factor (NGF), percentage of eosinophile (EOS), substance P (SP), inflammatory factors[hypersensitivity C reactive protein (hs-CRP), interleukin (IL)-17 and IL-23], and the occurrence of adverse reactions were compared. Result:The total effective rate of observation group was 93.0% (66/71), which was significantly higher than that of control group[81.7% (58/71), PP1%, FEF50 and FEF75 of two groups were increased significantly after treatment (PPPPConclusion:Modified Dingchuantang can effectively relieve cough and other symptoms in children with CVA, reduce airway inflammation, down-regulate the expressions of inflammatory factors in blood and improve airway function, with a definite curative effect, safety and reliability.
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Objective@#To study the airway inflammation feature difference in the patients with occupational pulmonary thesaurosis induced by iron.@*Methods@#Induced sputum samples were obtained from 20 healthy men, 20 patients with stable asthma, 25 patients with occupational pulmonary thesaurosis induced by iron. Differential cell counts in induced sputum were examined. The levels of supernatant IL-8 were measured by ELISA.@*Results@#The pulmonary function result was normal in the patients with pulmonary thesaurosis., their FVC (4.1±1.2) L was similar to FVC (4.3±0.9) L in mal group; but their FEV1.0 (2.9±0.9) L、FEV1/FVC (71.9%±5.4%) were lower than normal group’s FEV1.0 (3.2±0.7 L) 、FEV1.0/FVC (79.2%±9.9%) , and were hirher than asthma group’s FEV1 (2.5±0.8) L and FEV1.0/FVC (68.7%±6.1%) . In induced sputum, macrophages percentage in patients with pulmonary thesaurosis (54.3%±9.7%) was higher than asthma group and normal group (48.4±6.4, 51.9±7.3, P<0.05) , neutrophils percentage in patients with pulmonary thesaurosis group (43.9%±7.6%) was higher than asthma group and normal group (41.3%±7.1%, 39.8%±6.9%, P<0.05) , eosinophils percentage in patients with pulmonary thesaurosis group (0.3%±0.1%) was lower than asthma group (2.8±0.3, P<0.05) , lymphocytes percentage in patients with pulmonary thesaurosis group (2.0%±0.4%) was lower than asthma group (4.7±0.6, P<0.05) ; the sputum levels of IL-8 in patients with pulmonary thesaurosis group (914.7±24.3) pg/ml was higher than asthma group and normal group (747.9%±16.8 pg/ml, (405.4±13.7) pg/ml, P<0.05) .@*Conclusion@#Macrophages and IL-8 may play an important role in the pathogenesis of airway inflammation after long-term inhalation of iron and its compounds, the airway function in patients of occupational pulmonary thesaurosis was found damaged.
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<p><b>OBJECTIVE</b>To observe the role of myeloperoxidase(MPO)and eosinophilic cationic protein(ECP)in the airway inflammation and their correlation with clinical feature in asthma-COPD overlap (ACO) patients.</p><p><b>METHODS</b>Twenty patients with COPD, 20 with asthma, 20 with ACO and 20 control subjects underwent pulmonary function test for measurement of forced expiratory volume in 1 second (FEV), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum midexpiratory flow (MMF). COPD assessment test (CAT) was used to evaluate the clinical symptoms of the patients with COPD and ACO. The asthma control test (ACT) was used to evaluate the asthma control in the patients with asthma and ACO. Induced sputum samples were collected from the subjects for analysis of neutrophil and eosinophil ratios, and enzyme-linked immunosorbent assay was used to determine the expression levels of MPO and ECP in the sputum.</p><p><b>RESULTS</b>No significant difference was observed in the CAT scores between ACO group and COPD group (> 0.05). Compared with the asthma group, the patients with ACO had significantly lower ACT scores and lower FEV, PEF and MMF ( < 0.05). The patients with ACO had significantly higher FVC and sputum eosinophil ratio than those with COPD ( < 0.05), and a higher sputum neutrophil ratio than those with asthma ( < 0.01). In ACO group, the MPO level in sputum was significantly higher than that in the asthma group ( < 0.05), while sputum ECP level was significantly higher than that in both the asthma group and COPD group ( < 0.05 or 0.01). In ACO group, sputum MPO level was positively correlated with sputum neutrophil ratio (=0.8358, < 0.01) but was not correlated with CAT score or FEV (> 0.05); sputum ECP level was positively correlated with sputum eosinophil ratio (=0.4666, < 0.05) and was inversely correlated with ACT score (=-0.4966, < 0.05) and FEV (=-0.4610, < 0.05).</p><p><b>CONCLUSIONS</b>Both neutrophilic and eosinophilic inflammations occur in the airway of patients with ACO, and their sputum ECP level is negatively correlated with asthma control and obstructive airflow limitation.</p>
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Objective To determine the diagnostic value of ractional exhaled nitric oxide (FeNO) in eosinophils (EOS) bronchial asthma and its significance in appraising of therapeutic reaction of inhaled corticosteroids (ICS) for EOS bronchial asthma.Methods A total of sixty-two patients with bronchial asthma in the First Mfiliated Hospital of Xinxiang Medical University from April 2015 to February 2016 were selected as asthma group;at the same time,sixty-two healthy people were recruited as control group.The patients in asthma group were divided into EOS asthma group(n =31) and non EOS asthma group (n =31) according to the induced sputum cell count;the patients in EOS asthma group were divided into mild (n =7),moderate (n =13) and sever asthma group (n =1 1) according to the severity of the disease.The patients in asthma group were given conventional therapy(doxofylline 0.2 g intravenous infusion,two times per day;oral cetirizine 10 mg,one time per night;oral montelukast 10 mg,one time per night;budesonide 2 mg and compound ipratropium bromide solution 2.5 mL by aerosol rebreathing method,two times per day) for seven days.The pulmonary function,asthma control test(ACT) score,FeNO level and the ratio of EOS of patients were detected before and after treatment;the FeNO levels of person in the control group were tested.The FeNO levels of subjects were compared in each group;the correlation between FeNO level and EOS ratio was analysed in asthmatic group;the controlling rates of patients in asthmatic group were compared.Results Before treatment,the FeNO level in control group and asthma group was (9.57 ± 6.61),(30.23 ± 8.9 1) ppb respectively;the FeNO level in control group was significantly lower than that in asthma group (t =7.414,P ＜ 0.05).Before treatment,the FeNO level of patients in EOS asthma group and non EOS asthma group was (59.62 ± 29.04),(18.20 ± 11.33) ppb respectively;the FeNO level in non EOS asthma group was lower than that in EOS asthma group (t =6.568,P ＜ 0.05).In asthma group,the level of FeNO was positively correlated with EOS ratio(r =0.823,P ＜ 0.05).There was no statistic difference in FeNO level of patients in non EOS asthma group before and after treatment(t =2.013,P ＞ 0.05).The FeNO levels of patients in EOS asthma group after treatment were significantly lower than those before treatment (t =7.740,P ＜ 0.05);the FeNO levels of patients in mild,moderate and sever asthma group after treatment were significantly lower than those before treatment(t =3.535,8.171,7.161;P ＜0.05).The control rate of patients in EOS asthma group(67.7％,21/31) was significantly higher than that in the non EOS asthma group(22.6％,7/31) (x2 =12.765,P ＜0.05).The control rate of patients in mild,moderate and sever asthma group was 28.6％ (2/7),76.9 ％ (10/13) and 81.8 ％ (9/11) respectively;the control rate of patients in mild asthma group was significantly lower than that in moderate and sever asthma group (x2 =6.418,7.103;P ＜ 0.05);there was no statistic difference in control rate of patients between moderate asthma group and sever asthma group(x2 =7.103,P ＞ 0.05).Conclusion FeNO level can reflect the degree of airway inflammation,and can be used for the diagnosis of EOS phenotype asthma,and also has certain clinical value in evaluating the therapeutic reaction of ICS for treatment of EOS asthma.
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Induced sputum and sputum cell count analysis is a test for the diagnosis of various respiratory diseases. In particular, it has long been used as an important biomarker in the diagnosis or characterization of asthma or eosinophilic bronchitis. Despite a relatively long history of this test, there has been no consensus report for conducting and interpreting the analyses in Korea. Based on this awareness and necessity, the Korean Academy of Asthma, Allergy and Clinical Immunology launched the Standardization Committee to review the international guidelines and the literature and to develop a consensus report on the diagnostic procedure and interpretation of the sputum induction test.
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Allergy and Immunology , Asthma , Bronchitis , Cell Count , Consensus , Diagnosis , Eosinophils , Hypersensitivity , Korea , Methods , SputumABSTRACT
Objective To assess the effects of two different methods on differential cell count and the detection on inflammatory mediators in the process of induced sputum. Methods Induced sputum samples from outpatients with respiratory diseases were collected. Each sample was equally divided into two parts. One portion was processed at a regular way by incubation at 37 ℃ for 15 min in 0.1% dithiothreitol (DTT). Another was processed at 0 ℃ for 60 min in 0.1% DTT. The cell pellet was used for the cytology analysis by HE staining. The levels of IL-4,IL-5 and IL-8 were measured by Elisa Kit. Results Induced sputum was successfully collected from 20 subjects with chronic airway diseases ,including 7 males and 13 females . Total cell counts was lower in 0 ℃-incubated group than in 37 ℃-incubated group(P < 0.05). However,there was no difference in differential cell counts between two groups ,as well as the levels of IL-4 ,IL-5 and IL-8 in sputum supernatants(all P >0.05). Conclusions Except a difference in the total cell number ,there was no difference between two methods on the differential cell count and levels of certain inflammatory mediators.
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Objective To assess the effects of two different methods on differential cell count and the detection on inflammatory mediators in the process of induced sputum. Methods Induced sputum samples from outpatients with respiratory diseases were collected. Each sample was equally divided into two parts. One portion was processed at a regular way by incubation at 37 ℃ for 15 min in 0.1% dithiothreitol (DTT). Another was processed at 0 ℃ for 60 min in 0.1% DTT. The cell pellet was used for the cytology analysis by HE staining. The levels of IL-4,IL-5 and IL-8 were measured by Elisa Kit. Results Induced sputum was successfully collected from 20 subjects with chronic airway diseases ,including 7 males and 13 females . Total cell counts was lower in 0 ℃-incubated group than in 37 ℃-incubated group(P < 0.05). However,there was no difference in differential cell counts between two groups ,as well as the levels of IL-4 ,IL-5 and IL-8 in sputum supernatants(all P >0.05). Conclusions Except a difference in the total cell number ,there was no difference between two methods on the differential cell count and levels of certain inflammatory mediators.
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BACKGROUND: A sputum culture is the most reliable indicator of the infectiousness of pulmonary tuberculosis (PTB); however, a spontaneous sputum specimen may not be suitable. The aim of this study was to evaluate the infectious period in patients with non–drug-resistant (DR) PTB receiving adequate standard chemotherapy, using induced sputum (IS) specimens. METHODS: We evaluated the duration of infectiousness of PTB using a retrospective cohort design. RESULTS: Among the 35 patients with PTB, 22 were smear-positive. The rates of IS culture positivity from baseline to the sixth week of anti-tuberculosis medication in the smear-positive PTB group were 100%, 100%, 91%, 73%, 36%, and 18%, respectively. For smear-positive PTB cases, the median time of conversion to culture negativity was 35.0 days (range, 28.0–42.0 days). In the smear-negative PTB group (n=13), the weekly rates of positive IS culture were 100%, 77%, 39%, 8%, 0%, and 0%, respectively, and the median time to conversion to culture-negative was 21.0 days (range, 17.5–28.0 days). CONCLUSION: The infectiousness of PTB, under adequate therapy, may persist longer than previously reported, even in patients with non-DR PTB.
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Humans , Cohort Studies , Drug Therapy , Infectious Disease Incubation Period , Mycobacterium tuberculosis , Retrospective Studies , Sputum , Tuberculosis, PulmonaryABSTRACT
El tabaquismo es la principal causa de la EPOC, sin embargo, factores como la edad de diagnóstico, la historia previa de asma, exacerbaciones, predisposición genética y otros influirían en el desarrollo de la enfermedad. Esto estaría relacionado con los fenotipos de pacientes con EPOC, los cuales tendrían diferentes respuestas a los corticoides inhalados (CI). Recientemente, ha sido propuesto que los eosinófilos serían potenciales biomarcadores predictores de buena respuesta a los CI. Con la hipótesis de que la presencia de eosinófilos en esputo podría constituir una estrategia para diferenciar fenotipos de pacientes con EPOC, evaluamos los perfiles celulares infamatorios en muestras de esputo inducido en pacientes con EPOC no exacerbados. Para esto, se reclutaron 20 pacientes con EPOC moderado a severo que concurren al gimnasio de rehabilitación respiratoria, los cuales fueron agrupados en eosinofílicos (n: 8, cuando presentaron más de 3% de eosinófilos en la muestra de esputo inducido) o no eosinofílicos (n: 9). Se descartaron 3 muestras por contaminación con células epiteliales. Si bien no se observaron diferencias significativas en los test de función pulmonar o de marcha de 6 minutos, los pacientes con eosinoflia presentaron ligeramente mayor reversibilidad luego del broncodilatador. Además, tuvieron mayor eosinofilia periférica, mayores valores de FeNO y mejor calidad de vida (medida por cuestionarios) que los pacientes no eosinofílicos. El esputo inducido es una técnica no invasiva, económica, que representaría una herramienta útil para conocer los diferentes fenotipos inflamatorios en pacientes con EPOC.
Smoking is the major cause of COPD; however factors such as age, previous history of asthma, exacerbations, and genetic predisposition could infuence the development of the disease. This could be related with the phenotypes of COPD patients, who would have different responses to inhaled corticosteroids (ICs). Recently, it has been suggested that eosinophils are potential biomarkers that contribute to predict good response to ICs. To test the hypothesis that the presence of eosinophils in sputum could be useful to characterize different phenotypes of COPD patients, we assessed the infammatory cell profles in induced sputum samples from not exacerbated COPD patients. 20 patients with moderate to severe COPD, attending a pulmonary rehabilitation gym, were grouped into eosinophilic (8 patients who presented more than 3% eosinophils in the induced sputum sample) or neutrophilic (9 patients who had more than 60% neutrophils). Only 3 patients were excluded due to contamination of the sputum with epithelial cells. Although there were no-signifcant differences in the pulmonary function tests or the 6-minute walk, the patients with eosinophilia showed higher responsiveness to bronchodilator therapy. Besides this group presented an increase of peripheral eosinophils, higher FeNO and better quality of life (measured by questionnaires) compared with the neutrophilic patients. Induced sputum is an economic non-invasive technique and would be a useful tool to know different infammatory phenotypes in COPD patients.
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Sputum , Adrenal Cortex Hormones , Pulmonary Disease, Chronic Obstructive , EosinophilsABSTRACT
Objective To investigate the value of fractional exhaled nitric oxide (FeNO) in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Methods The twenty-eight ACOS patients receiving no standardmedication treatment were recruited from May 2015 to Oct. 2015 in Suzhou Kowloon Hospital; the patients inhaled corticosteroids/long-acting beta agonist (ICS/LABA) for 12 weeks and the changes of FeNO levels, FEV1%pred, induced sputum eosinophil (EOS), blood total IgE, and high sensitivity C-reactive protein (hs-CRP) were examined before and after treatment. The correlations between FeNO and other indices were analyzedby Pearson correlation coefficient method. The patients were divided into different groups according to different age and smoking statuses, and the changes of the indices before and after treatment were compared between different groups. Twenty-eight healthy participants were recruited as control group and their FeNO levels were also tested. Results After treatment, the FeNO levels ([32. 04±8. 34] × 10-9 mol/L vs [25. 56 ±13] ×10-9 mol/L, P<0. 05), induced sputum EOS ([18. 51 ± 5. 36]% vs [13. 18 ± 1. 56]%, P<0. 05), and blood total IgE ([251. 91 ± 42. 24] ng/mL vs [204. 65 ± 28. 52] ng/mL, P<0. 05) of ACOS patients were significantly lower than those before treatment. There was no significant difference in FEV1%pred ([52. 03 ± 7. 03-% vs [55. 16 ± 8. 20-%, P = 0. 391) or hs-CRP ([10. 86 ± 4. 92- mg/L vs [9. 16 ± 1. 82) mg/L, P = 0. 077) before and after treatment in ACOS patients. Meanwhile, the levels of FeNO in ACOS group were significantly higher than those in the healthy control group before and after treatment ([32. 04±8. 34-×10-9 mol/L, [25. 56 ± 4. 13×10-9 mol/L vs [17. 04+0. 97×10-9 mol/L,P<0. 05). The levels of FeNO, induced sputum EOS and serum total IgE were significantly different among different ages and smoking status before and after ICS/LABA treatment. The pre- and post-treatment FeNO levels were positively correlated with induced sputum EOS and serum total IgE (pre-treatment; r=S 92S, P<0. 01 and s=S I4I, P<0. 01; sost-treatment; r=0. 247, P<0. 01 and r=0. 443, P<0. 01); while it was not correlated with serumhs-CRP or FEV1%pred. Conclusion Our findings indicate that eosinophilic inflammation is present in the airways of ACOS patients, which can be treated with ICS/LABA inhalation. The curative effect is not affected by age or smoking status. FeNO detection can be used to evaluate the efficacy of ICS/LABA for ACOS, which is associated with induced sputum EOS and serum total IgE.
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Objective Nonallergic rhinitis with eosinophilia syndrome (NARES) is associated with such diseases as bronchial asthma , nasal polyps , and aspirin intolerance , but there is a lack of studies on its inflammatory conditions .The aim of this study is to describe the inflammation characteristics of NARES . Methods This study included 101 cases of allergic rhinitis ( AR) , 39 cases of NARES, and 162 adult controls .We analyzed the inflammation char-acteristics of the patients using skin prick test ( SPT) , nasal douche , fractional exhaled nitric oxide ( FeNO ) measurement , serum eosino-phil (EOS) counting, serum total IgE (tIgE) determination, induced sputum detection, and nasal and bronchial provocation tests . Results Compared with the controls , the NARES and AR groups showed significant increases in the positive rate of nasal provocation (32.1%vs 69.2%and 75.2%, P<0.05), positive rate of bronchial provocation (1.2%vs 10.3%and 14.9%, P<0.05), and FeNO level ([15.70 ±5.20] ppb vs [37.25 ±22.95] and [39.00 ±24.29] ppb, P<0.05), as well as in the serum EOS and tIgE levels, EOS count, and ratio of EOS in the induced sputum (P<0.05).However, the level of serum tIgE was significantly lower in the NARES than in the AR group (53.3 [23.3-186.0] kU/L vs 197.0 [62.6-391.0] kU/L, P<0.05). Conclusion NARES is a syndrome with nasal, lower airway, and systematic inflammation, similar to AR in inflammatory intensity.Therefore, for patients with NARES, attention should be paid not only to upper airway but also to lower airway and systemic inflammation .
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Background: The diagnosis of Pulmonary Tuberculosis is largely dependent of the positive result of the sputum smear by ZN staining. But in many cases, although active tuberculosis is present, due to many reasons, sputum smear may yield a negative result. With a late culture result, no reliable serological test available to enable an early diagnosis, role of induced sputum and bronchoscopy has been tried with excellent results. Methods: 50 fresh smear negative cases between the ages of 16-65 years, clinically and radiologically suspected of Pulmonary Tuberculosis were subjected to induced sputum and bronchoscopy after detailed history and thorough clinical examination as done. Clinical symptoms were noted, 2 sputum smears (spot and early morning) and chest x-rays were taken for all patients. Results: Males between 24 – 44 years were seen to be predominant patients. The most common symptom appeared to be cough in 80% followed by fever in 60% of the cases. 76% of patients had unilateral lesions and 24% with bilateral lesions. 84% of the sputum negative patents were identified as active tuberculosis cases. Conclusion: Induced sputum and fiber optic bronchoscopy with bronchial aspirate and post bronchoscopic sputum can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria. There is minimum patient discomfort, reduced complications and relatively good yield which makes these procedures justifiable in the diagnosis of fresh smear negative pulmonary tuberculosis.
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PURPOSE: To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB). MATERIALS AND METHODS: Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum. RESULTS: A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease (non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate results was significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12). CONCLUSION: IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiological tools in the rapid diagnosis of smear-negative TB.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Enzyme-Linked Immunospot Assay , Immunologic Tests/methods , Mycobacterium tuberculosis/isolation & purification , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosisABSTRACT
Objective To describe the effects of allergic and nonallergic rhinitis on patients with bronchial inflammation by comparing the bronchial inflammation characteristics . Methods All patients enrolled in the study were categorized into two groups according to rhinitis diagnostic criteria , 377 cases in the allergic rhinitis ( AR) group, 262 cases in non-allergic rhinitis ( NAR) group and another 264 patients without rhinitis as control group .Induced sputum differential cytology tests , exhaled nitric oxide concentration measurements and methacholine bronchial provocation tests were performed .The characteristics and differences in lower airway inflam-mation among the three groups were compared . Results The exhaled nitric oxide level and the positive rate of the exhaled nitric ox-ide were different significantly in AR group and NAR group than the control group (P0.05). Conclusion Bronchial inflammation may be aggravated by AR and NAR , so all patients with AR and NAR need treatment , and the degree of inflammation was higher in AR patients than the NAR patients .
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Objective To study the correlation between the level of serum high sensitivity C-reactive protein (hs-CRP) and induced sputum cell counts,pulmonary function and asthma control test (ACT) in order to investigate the clinical application value of serum hs-CRP for the acute exacerbation bronchial asthma patients.Methods Thirty acute exacerbation bronchial asthma patients were collected as asthma group,14 healthy people during the same period were collected as control group.The fasting serum hs-CRP was examined in control group and before and after treatment of 5-7 d in asthma group.The induced sputum was obtained by ultrasonic atomizer 4.5％ sodium chloride,and the percentage of eosinophils (EOS％),neutrophil,macrophages,lymphocytes was calculated.The pulmonary function index was determined in control group and before and after treatment in asthma group.ACT score was performed in asthma group.The correlation between the serum hs-CRP and induced sputum differential leukocyte count,the pulmonary function index and ACT score was analyzed by Spearman correlation analysis.The effect of the serum hs-CRP and induced sputum EOS％ on inflammatory response of acute exacerbation bronchial asthma was evaluated by receiver operating characteristic (ROC) curve analysis.Results Two cases were excluded in asthma group.The serum hs-CRP before and after treatment in asthma group was higher than that in control group[4.18(2.12-11.12) and 3.40(2.02-8.91) mg/L vs.1.48(1.03-4.81) mg/L,H =18.939,P＜ 0.01].The serum hs-CRP before treatment was higher than that after treatment in asthma group (P ＜ 0.01).In asthma group,the serum hs-CRP had positive relationship with induced sputum EOS％ (r =0.849,P =0.000).There were negative correlations between the serum hs-CRP and the pulmonary function index such as one second forced expiratory volume percent predicted,one second forced expiratory volume occupied vital capacity ratio,maximum mid-expiratory flow percentage of predicted (r =-0.617,-0.559,-0.398,respectively,P =0.000,0.002,0.036,respectively).It was also found that the serum hs-CRP and ACT score had the remarkable Spearman linear correlation (r =-0.511,P =0.005).The area under the ROC curve of the serum hs-CRP was 0.713 (P =0.003).Conclusions There are significant correlations between the serum hs-CRP and induced sputum EOS％,pulmonary function,ACT score in the acute exacerbation bronchial asthma patients.It is found that hs-CRP could be considered as one of the potential marker to evaluate the systemic inflammation level of bronchial asthma.
ABSTRACT
BACKGROUND: Bronchial asthma is usually associated with high sputum eosinophil levels. However, recent reports have suggested the importance of noneosinophilic asthma (NEA) as a distinct phenotype of asthma. OBJECTIVE: The aim of this study was to evaluate clinical significance of sputum eosinophilia and long-term treatment outcomes related to sputum eosinophilia in Korean asthmatics. METHODS: A total of 201 steroid-naive asthmatics who had undergone induced sputum analysis at baseline were selected from the Cohort for Reality and Evolution of Adult Asthma study population. Clinical evaluation, spirometry, a skin-prick test, a methacholine bronchial provocation test, and sputum eosinophil analysis were performed initially, and patients received the treatment recommended by the Global Initiative for Asthma. Lung function was evaluated every 6 months, and 53 patients completed 24 months of regular follow-up visits. Sputum eosinophilia was defined as a sputum eosinophil count of >3%.