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Schultz A, Balaguruswamy S, Dentice R, Dobler CC, Geake J, Gibson P, Goulter P, Jayaram L, Laird PJ, Middleton PG, Seale H. Thoracic Society of Australia and New Zealand position statement: The safe clinical use of sputum induction for bio-sampling of the lower airways in children and adults. Respirology 2024; 29:372-378. [PMID: 38556839 DOI: 10.1111/resp.14707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
Sputum induction is widely used in clinical settings for collection of biological samples from the lower airways. However, in recent years sputum induction has been associated with serious adverse events and even death. This position statement was commissioned by the Thoracic Society of Australia and New Zealand to address major adverse events of two deaths associated with sputum induction that have occurred in Australia in 2021, and outlines best practice for the safe use of sputum induction. The statement resulted from systematic literature searches by a multi-disciplinary group including respiratory physicians, nurses and physiotherapists (paediatric and adults focused). Consumers had input to an advanced draft of the position statement. The position statement covers indications for sputum induction, informed consent, scope of practice of personnel administering the procedure, infection control considerations, details about the sputum induction procedure, safety considerations and risk assessment in clinical settings.
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Affiliation(s)
- André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Sathya Balaguruswamy
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ruth Dentice
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Claudia C Dobler
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - James Geake
- Department of Thoracic and Sleep Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Patricia Goulter
- Physiotherapy Department, Te Whatu Ora (Health New Zealand), Wellington, New Zealand
| | - Lata Jayaram
- Department of Respiratory and Sleep Medicine, Western Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Pamela J Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Peter G Middleton
- Westmead Clinical School, University of Sydney, Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Helen Seale
- Department of Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Dragonieri S, Bikov A, Capuano A, Scarlata S, Carpagnano GE. Methodological Aspects of Induced Sputum. Adv Respir Med 2023; 91:397-406. [PMID: 37887074 PMCID: PMC10603896 DOI: 10.3390/arm91050031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
We aimed to conduct a state-of-the-art review of the current literature and offer further insights into the methodological aspects concerning induced sputum. The increasing popularity of sputum induction as a non-invasive and cost-effective method for obtaining lower airway secretions from patients who cannot produce sputum naturally has led to extensive research and applications in respiratory conditions like asthma and COPD. This technique allows for analysis of the cellular and biochemical components of the sputum to take place, providing insights into airway inflammation, immune cells, and help in predicting treatment response. Furthermore, induced sputum enables various analyses, including microRNA and gene expression studies and immunophenotyping. The procedure is generally safe and well tolerated, even in patients with airflow limitations; however, monitoring lung function is essential, especially in those with airway hyperresponsiveness. Optimal saline solution concentration and inhalation duration have been investigated, recommending a 15-20 min induction with hypertonic saline. Expectoration involves coughing at the end of each inhalation time. Careful handling during sputum processing is necessary for obtaining accurate results in cell cytology, immunocytochemistry, and in situ hybridization. Overall, induced sputum offers significant advantages as a preferred alternative for large-scale and repeated airway sampling, despite some technical demands and limitations.
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Affiliation(s)
- Silvano Dragonieri
- Department of Respiratory Diseases, University of Bari, 70124 Bari, Italy; (S.D.); (A.C.); (G.E.C.)
| | - Andras Bikov
- Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PT, UK
| | - Alessandro Capuano
- Department of Respiratory Diseases, University of Bari, 70124 Bari, Italy; (S.D.); (A.C.); (G.E.C.)
| | - Simone Scarlata
- Department of Internal Medicine, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Bio-Medical Campus, 00128 Rome, Italy;
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Abstract
Tuberculosis (TB) remains the leading cause of bacterial disease-related death and is among the top 10 overall causes of death worldwide. The complex nature of this infectious lung disease has proven difficult to treat, and significant research efforts are now evaluating the feasibility of host-directed, adjunctive therapies. An attractive approach in host-directed therapy targets host epigenetics, or gene regulation, to redirect the immune response in a host-beneficial manner. Substantial evidence exists demonstrating that host epigenetics are dysregulated during TB and that epigenetic-based therapies may be highly effective to treat TB. However, the caveat is that much of the knowledge that exists on the modulation of the host epigenome during TB has been gained using in vitro, small-animal, or blood-derived cell models, which do not accurately reflect the pulmonary nature of the disease. In humans, the first and major target cells of Mycobacterium tuberculosis are alveolar macrophages (AM). As such, their response to infection and treatment is clinically relevant and ultimately drives the outcome of disease. In this review, we compare the fundamental differences between AM and circulating monocyte-derived macrophages in the context of TB and summarize the recent advances in elucidating the epigenomes of these cells, including changes to the transcriptome, DNA methylome, and chromatin architecture. We will also discuss trained immunity in AM as a new and emerging field in TB research and provide some perspectives for the translational potential of targeting host epigenetics as an alternative TB therapy.
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Winter NA, Gibson PG, Fricker M, Simpson JL, Wark PA, McDonald VM. Hemopexin: A Novel Anti-inflammatory Marker for Distinguishing COPD From Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:450-467. [PMID: 33733639 PMCID: PMC7984952 DOI: 10.4168/aair.2021.13.3.450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/14/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022]
Abstract
Purpose Systemic inflammatory biomarkers can improve diagnosis and assessment of chronic obstructive pulmonary disease (COPD) and asthma. We aimed to validate an airway disease biomarker panel of 4 systemic inflammatory biomarkers, α2-macroglobulin, ceruloplasmin, haptoglobin and hemopexin, to establish their relationship to airway disease diagnosis and inflammatory phenotypes and to identify an optimized biomarker panel for disease differentiation. Methods Participants with COPD or asthma were classified by inflammatory phenotypes. Immunoassay methods were used to measure levels of validation biomarkers in the sera of participants with disease and non-respiratory disease controls. Markers were analyzed individually and in combination for disease differentiation and compared to established biomarkers (C-reactive protein, interleukin-6, and white blood cell/blood eosinophil count). Results The study population comprised of 141 COPD, 127 severe asthma, 54 mild-moderate asthma and 71 control participants. Significant differences in ceruloplasmin, haptoglobin and hemopexin levels between disease groups and between systemic inflammatory phenotypes were observed. However, no differences were found between airway inflammatory phenotypes. Hemopexin was the best performing individual biomarker and could diagnose COPD versus control participants (area under the curve [AUC], 98.3%; 95% confidence interval [CI], 96.7%–99.9%) and differentiate COPD from asthmatic participants (AUC, 97.0%; 95% CI, 95.4%–98.6%), outperforming established biomarkers. A biomarker panel, including hemopexin, haptoglobin and other established biomarkers, could diagnose asthma versus control participants (AUC, 87.5%; 95% CI, 82.8%–92.2%). Conclusions Hemopexin can be a novel biomarker with superior diagnostic ability in differentiating COPD and asthma. We propose an anti-inflammatory axis between the airways and systemic circulation, in which hemopexin is a protective component in airway disease.
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Affiliation(s)
- Natasha A Winter
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Health Lungs, The University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Health Lungs, The University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Michael Fricker
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Health Lungs, The University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Jodie L Simpson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Peter A Wark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Health Lungs, The University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Health Lungs, The University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia.
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Koc-Günel S, Schubert R, Zielen S, Rosewich M. Cell distribution and cytokine levels in induced sputum from healthy subjects and patients with asthma after using different nebulizer techniques. BMC Pulm Med 2018; 18:115. [PMID: 30005648 PMCID: PMC6045886 DOI: 10.1186/s12890-018-0683-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sputum induction is an important noninvasive method for analyzing bronchial inflammation in patients with asthma and other respiratory diseases. Most frequently, ultrasonic nebulizers are used for sputum induction, but breath-controlled nebulizers may target the small airways more efficiently. This treatment may produce a cell distribution similar to bronchoalveolar lavage (less neutrophils and more macrophages) and provide deeper insights into the underlying lung pathology. The goal of the study was to compare both types of nebulizer devices and their efficacy in inducing sputum to measure bronchial inflammation, i.e., cell composition and cytokines, in patients with mild allergic asthma and healthy controls. METHODS The population of this study consisted of 20 healthy control subjects with a median age of 17 years, range: 8-25 years, and 20 patients with a median age of 12 years, range: 8-24 years, presenting with mild, controlled allergic asthma who were not administered an inhaled steroid treatment. We induced sputum in every individual using both devices on two separate days. The sputum weight, the cell composition and cytokine levels were analyzed using a cytometric bead assay (CBA) and by real-time quantitative PCR (qRT-PCR). RESULTS We did not observe significant differences in the weight, cell distribution or cytokine levels in the sputum samples induced by both devices. In addition, the Bland-Altman correlation revealed good concordance of the cell distribution. As expected, eosinophils and IL-5 levels were significantly elevated in patients with asthma. CONCLUSIONS The hypothesis that sputum induction with a breath-controlled "smart" nebulizer is more efficient and different from an ultrasonic nebulizer was not confirmed. The Bland-Altman correlations showed good concordance when comparing the two devices. TRIAL REGISTRATION NCT01543516 Retrospective registration date: March 5, 2012.
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Affiliation(s)
- Sinem Koc-Günel
- Department for Children and Adolescents, Division for Allergology, Pneumology and Cystic Fibrosis, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. .,Department of Internal Medicine, Division of Pneumology, University Hospital Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | - Ralf Schubert
- Department for Children and Adolescents, Division for Allergology, Pneumology and Cystic Fibrosis, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Division for Allergology, Pneumology and Cystic Fibrosis, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Martin Rosewich
- Department for Children and Adolescents, Division for Allergology, Pneumology and Cystic Fibrosis, University Hospital Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Zhu Z, Xie Y, Guan W, Gao Y, Xia S, Huang R, Zhong N, Zheng J. Effects of leukotriene D 4 and histamine nasal challenge on airway responsiveness and inflammation in persistent allergic rhinitis patients. CLINICAL RESPIRATORY JOURNAL 2016; 12:587-594. [PMID: 27696764 DOI: 10.1111/crj.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 09/10/2016] [Accepted: 09/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both histamine and leukotrienes are implicated in the pathogenesis of allergic rhinitis (AR), although the pattern and severity of the nasal response to these two potent inflammatory mediators may differ, which has not been adequately studied in patients with persistent AR. OBJECTIVE We sought to compare the differential effects of nasal challenge with leukotriene D4 (LTD4 ) and histamine on the airway response and inflammation in patients with AR. METHODS An open-label, crossover study was performed in 25 persistent AR patients (AR group) and 16 healthy subjects (control group). Participants randomly underwent histamine and LTD4 nasal provocation within a two-week interval. Nasal symptoms according to a visual analogue scale (VAS), fractional exhaled nitric oxide (FENO), nasal lavage, induced sputum, and spirometry were evaluated before and after nasal challenge. RESULTS Nasal airway resistance (NAR) increased significantly after both LTD4 and histamine nasal challenge in AR patients (P < .05). The potency of LTD4 was 142-fold higher than that of histamine in increasing NAR (P < .001). The nasal symptom score induced by histamine challenge was significantly higher than that triggered by LTD4 (3.42 ± 0.83 vs. 1.16 ± 0.94, P < .05) in the AR group. LTD4 and histamine nasal challenge led to a significant increase in neutrophils in the nasal lavage and induced sputum (P < .05) in AR patients. There were no significant differences in the changes of eosinophils before and after LTD4 and histamine nasal challenges in nasal lavage and induced sputum. No significant changes in NAR, the induced symptom score, or inflammatory cells in the nasal lavage and sputum were found in the control group. CONCLUSIONS LTD4 and histamine nasal challenge caused different patterns and severities of nasal symptoms, which correlated with symptoms (TSS) that affect patient's daily life. LTD4 was far more potent than histamine at increasing the NAR, while histamine nasal challenge induced more sneezing and nasal discharge. These results may guide the prescription of anti-histamine or anti-leukotriene agents for treating different AR phenotypes.
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Affiliation(s)
- Zheng Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yanqing Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Weijie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yi Gao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Shu Xia
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Rongquan Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jinping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
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Chen JH, Qin L, Shi YY, Feng JT, Zheng YL, Wan YF, Xu CQ, Yang XM, Hu CP. IL-17 protein levels in both induced sputum and plasma are increased in stable but not acute asthma individuals with obesity. Respir Med 2016; 121:48-58. [PMID: 27888992 DOI: 10.1016/j.rmed.2016.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity worsens asthma control partly through enhanced airway neutrophilia, altered lung mechanics and comorbidities, including obstructive sleep apnea syndrome, gastroesophageal reflux disease and depression. Although controversial, obesity may also cause poorer outcomes in acute asthma. IL-17 is associated with neutrophilic inflammation, steroid resistance and severe asthma, but its importance in the association between asthma and obesity is unknown. OBJECTIVE To investigate the role of IL-17 in obese asthma in both acute and stable settings. METHODS Both stable (n = 177) and acute (n = 78) asthmatics were recruited and categorized into lean (n = 77 and 39 respectively), overweight (n = 41 and 17 respectively) and obese (n = 59 and 22 respectively) groups and compared for clinical characteristics, including sputum and plasma IL-17 protein concentrations, sputum cellularity, spirometry and comorbidities. Correlations of IL-17 expression with other measures were explored. RESULTS In stable subjects, airway neutrophilia and IL-17 concentrations were most prominent in the obese, and correlated positively with each other. Significant increase in plasma IL-17 levels was also noted and associated with elevated depressive symptoms in obesity. In acute asthma, IL-17 expression, like most other clinical measures, was similar among lean, overweight and obese groups, but was higher in acute versus stable asthma subjects, with sputum IL-17 correlating positively with sputum neutrophils and negatively with FEV1 and plasma IL-17 showing a positive connection to airway eosinophilia during exacerbation. CONCLUSIONS IL-17 contributes to worse disease control in obese asthma through enhancing airway neutrophilia and depression, and may implicate in asthma exacerbations. Effects of adiposity on acute asthma remain uncertain.
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Affiliation(s)
- Jian-Hui Chen
- Department of Respiratory Medicine, Xiangya Hospital of Central South University (Key Site of National Clinical Research Center for Respiratory Disease), Changsha 410008, Hunan Province, China; Department of Respiratory Medicine, Huai'an Second People's Hospital, Huai'an 223002, Jiangsu Province, China.
| | - Ling Qin
- Department of Respiratory Medicine, Xiangya Hospital of Central South University (Key Site of National Clinical Research Center for Respiratory Disease), Changsha 410008, Hunan Province, China.
| | - Ying-Ying Shi
- Key Laboratory for Medicinal Exploitation of Huai'an Regional Resource, College of Chemical Engineering, Huaiyin Institute of Technology, Huai'an 223003, Jiangsu Province, China.
| | - Jun-Tao Feng
- Department of Respiratory Medicine, Xiangya Hospital of Central South University (Key Site of National Clinical Research Center for Respiratory Disease), Changsha 410008, Hunan Province, China.
| | - Yu-Long Zheng
- Department of Respiratory Medicine, Huai'an Second People's Hospital, Huai'an 223002, Jiangsu Province, China.
| | - Yu-Feng Wan
- Department of Respiratory Medicine, Huai'an Second People's Hospital, Huai'an 223002, Jiangsu Province, China.
| | - Chuan-Qin Xu
- Department of Respiratory Medicine, Huai'an Second People's Hospital, Huai'an 223002, Jiangsu Province, China.
| | - Xiao-Mei Yang
- Department of Respiratory Medicine, Huai'an Second People's Hospital, Huai'an 223002, Jiangsu Province, China.
| | - Cheng-Ping Hu
- Department of Respiratory Medicine, Xiangya Hospital of Central South University (Key Site of National Clinical Research Center for Respiratory Disease), Changsha 410008, Hunan Province, China.
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Shimoda T, Obase Y, Nagasaka Y, Nakano H, Kishikawa R, Iwanaga T. Lung Sound Analysis and Airway Inflammation in Bronchial Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:505-11. [PMID: 27021633 DOI: 10.1016/j.jaip.2016.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/22/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our previous study on lung sound analysis (LSA) revealed that the expiration-to-inspiration sound power ratio in a low-frequency range (E/I LF) was increased in patients with bronchial asthma, even when they have no wheezes. OBJECTIVE We also monitored the expiration-to-inspiration sound power ratio in a mid-frequency range (E/I MF) and the mid- to low-frequency sound power ratio for inspiration and expiration (ie, I MF/LF and E MF/LF, respectively) using a new software program to examine which parameter is most suitable as an index of airway inflammation in patients with asthma. METHODS A study was conducted in 31 patients with mild-to-moderate bronchial asthma to examine potential correlations of LSA parameters (E/I LF, E/I MF, I MF/LF, and E MF/LF) with spirogram parameters, airway hyperresponsiveness (PC20), fractional exhaled nitric oxide (NO), and sputum eosinophils. RESULTS E/I LF was significantly correlated with airway narrowing (forced expiratory volume in 1 second [FEV1.0]/forced vital capacity [FVC]%: r = -0.50, maximal expiratory flow at 50% [V50],%pred: r = -0.50) and peripheral airway inflammation (alveolar NO: r = 0.36, eosinophils in peripheral sputum: r = 0.41). E/I MF was significantly correlated with airway narrowing (FEV1.0/FVC%: r = -0.46, V50,%pred: r = -0.49), airway inflammation (bronchial NO: r = 0.43, alveolar NO: r = 0.47, eosinophils in peripheral sputum: r = 0.50), and airway hyperresponsiveness (logPC20: r = -0.49). E MF/LF was significantly correlated with airway inflammation (NO: r = 0.36, eosinophils in sputum: r = 0.40) and airway hyperresponsiveness (logPC20: r = -0.40). I MF/LF was not significantly correlated with any parameters. CONCLUSIONS Among the 4 LSA parameters investigated, E/I MF demonstrated the highest correlation with airway inflammation, and also with bronchial hyperresponsiveness.
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Affiliation(s)
- Terufumi Shimoda
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan.
| | - Yasushi Obase
- Second Department of Internal Medicine, School of Medicine, Nagasaki University, Nagasaki, Japan
| | | | - Hiroshi Nakano
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
| | - Reiko Kishikawa
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
| | - Tomoaki Iwanaga
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
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Identification and validation of nebulized aerosol devices for sputum induction. Can Respir J 2013; 21:101-6. [PMID: 24288700 DOI: 10.1155/2014/925305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Induced sputum cell counts are a noninvasive and reliable method for evaluating the presence, type and degree of airway inflammation in patients with asthma. Currently, standard nebulizer devices used for sputum induction in multiple patients are labelled as single-patient devices by the manufacturer, which conflicts with infection prevention and control requirements. As such, these devices cannot feasibly be used in a clinical sputum induction program. Therefore, there is a need to identify alternative nebulizer devices that are either disposable or labelled for multipatient use. OBJECTIVE To apply validated rigorous, scientific testing methods to identify and validate commercially available nebulizer devices appropriate for use in a clinical sputum induction program. METHODS Measurement of nebulized aerosol output and size for the selected nebulizer designs followed robust International Organization for Standardization methods. Sputum induction using two of these nebulizers was successfully performed on 10 healthy adult subjects. The cytotechnologist performing sputum cell counts was blinded to the type of nebulizer used. RESULTS The studied nebulizers had variable aerosol outputs. The AeroNeb Solo (Aerogen, Ireland), Omron NE-U17 (Omron, Japan) and EASYneb II (Flaem Nuova, Italy) systems were found to have similar measurements of aerosol size. There was no significant difference in induced sputum cell results between the AeroNeb Solo and EASYneb II devices. DISCUSSION There is a need for rigorous, scientific evaluation of nebulizer devices for clinical applications, including sputum induction, for measurement of cell counts. CONCLUSION The present study was the most comprehensive analysis of different nebulizer devices for sputum induction to measure cell counts, and provides a framework for appropriate evaluation of nebulizer devices for induced sputum testing.
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Teig N, Allali M, Rieger C, Hamelmann E. Inflammatory markers in induced sputum of school children born before 32 completed weeks of gestation. J Pediatr 2012; 161:1085-90. [PMID: 22863260 DOI: 10.1016/j.jpeds.2012.06.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 05/09/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To test whether chronic bronchial inflammation may be a contributing risk factor for persistent airflow limitation in children born before 32 weeks of gestation in later life. STUDY DESIGN Thirty-six of 160 children born before 32 completed weeks of gestation who were born between 1988 and 1992 were recruited at a median age of 11 years. Eighteen age-matched children born at term were controls; 47% of the premature infants and 61% of the term born children produced sputum of sufficient quality for interleukin (IL)-8, cell numbers, and differential counts. RESULTS Compared with term born children, sputum from the premature group had a higher proportion of neutrophils (62% vs 3.8%; P < .001) and higher IL-8/protein values (1.93 μg/g vs 0.64 μg/g; P = .008). Forced expiratory flow 25%-75% and forced expiratory volume in 1 second/vital capacity were significantly lower (73.4 % vs 116% predicted, P = .002 and 97% vs 101%, P = .012, respectively). Lung function values and sputum indices did not correlate. IL-8/protein and neutrophil percentages correlated significantly with decreasing gestational age (Spearman rank coefficient = -0.58, P = .020 and -.70, P =.03 respectively). CONCLUSION A significant proportion of school children born very preterm demonstrate persistent peripheral airway obstruction that is accompanied by neutrophilic lower airway inflammation.
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Affiliation(s)
- Norbert Teig
- University Children's Hospital, St-Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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Gao P, Gibson PG, Zhang J, He X, Hao Y, Li P, Liu H. The safety of sputum induction in adults with acute exacerbation of COPD. CLINICAL RESPIRATORY JOURNAL 2012; 7:101-9. [PMID: 22452898 DOI: 10.1111/j.1752-699x.2012.00291.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Induced sputum is a non-invasive method, and a useful tool to evaluate inflammatory cells and mediators in the airway lumen in the setting of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the inhalation of hypertonic saline solution to induce sputum may cause a bronchoconstrictive response, so it is important to evaluate the success and safety of sputum induction (SI). OBJECTIVES The aims of this study were to assess the safety and efficacy of SI in adults with AECOPD. METHODS Eighty-three AECOPD subjects and 26 healthy controls underwent a modified SI. The outcome measures included fall in lung function during induction and success of SI. RESULTS Adults hospitalized with AECOPD had moderate to very severe airflow obstruction. SI was successful in over 80% of subjects. The percentage decrease in forced expiratory volume in 1s (FEV1 ) from baseline by the Global initiative for Chronic Obstructive Lung Disease (GOLD) category was median 1.2(interquartile range, 0.5-3.3)(GOLD II), 2.3(1.3-3.2)(GOLD III), 5.2(3.3-8.6)(GOLD IV) and 1.4(0.5-3.2)(control), respectively. A fall in FEV1 of >20% occurred in only one subject with AECOPD who was in GOLD category III. The decrease in percentage of FEV1 from baseline was greatest in the second stage of induction, and correlated with that of the final stage (r=0.589; P=0.01). The fall in FEV1 during induction increased with GOLD category (P<0.05). CONCLUSIONS SI can be safely and successfully performed in patients with moderate to very severe chronic obstructive pulmonary disease who experience an exacerbation using this modified induction protocol. The early decrease in FEV1 can be used to predict the maximum fall.
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Affiliation(s)
- Peng Gao
- Department of Respiratory Medicine, The Second Affiliated Hospital of Jilin University, Changchun, Jilin, China
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Vizmanos Lamotte G, Moreno Galdó A, Cruz Carmona MJ, Muñoz Gall X, Gómez Olles S, de Mir Messa I, Gartner S, Martín de Vicente C. [Sputum induction in children: Technical development]. An Pediatr (Barc) 2010; 72:199-204. [PMID: 20138598 DOI: 10.1016/j.anpedi.2009.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 10/13/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To compare low and high flow nebulizers performance (total of samples) and its side effects on sputum induction in asthmatic children. PATIENTS AND METHODS Sputum induction was performed by inhalation of a hypertonic saline solution at increasing concentrations (3%, 4% and 5%) using low flow (OMRON NE-U07; flow rate 1ml/min), or high flow (OMRON NE-U12; flow rate 3ml/min, and DeVilbiss Ultraneb 3000; flow rate 2.5ml/min) ultrasonic nebulizers. RESULTS We performed 49 inductions in 49 patients from 7 to 15 years old (in 15 children we used a low flow nebulizer (Omron NE-U07) and in 34 children a high flow nebulizer (OMRON NEU12, 6 patients, and DeVilbiss Ultraneb 3000, 28 patients). We obtained 37 samples of which 36 had less than 20% of squamous cells, and 26 had a viability > or =60%. The test performance was higher with high-flow nebulizers, obtaining 85.3% of samples compared to 53% (p=0.04). A total of 69% of samples obtained with the high flow nebulizer were valid, compared to 62.5% (p=0.7) with the low flow nebulizers. With high flow rate nebulizers the incidence of cough (17.6%, p=0.08) and itchy eyes (0%, p=0.02) decreased with the low flow nebulizer (47% and 20% respectively), but bad taste (82.3%, p <0.001) and salivation (14.7%, p=0.3) increased. CONCLUSIONS With high flow rate ultrasonic nebulizers we obtain a higher performance of the technique without an increase in significant side effects.
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Bathoorn E, Liesker J, Postma D, Koëter G, van Oosterhout AJM, Kerstjens HAM. Safety of sputum induction during exacerbations of COPD. Chest 2007; 131:432-8. [PMID: 17296644 DOI: 10.1378/chest.06-2216] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Sputum induction (SI) is considered to be a safe tool for assessing airway inflammation in stable patients with COPD, but little is known about its safety during exacerbations. We therefore assessed the safety of SI during COPD exacerbations. SI data from 44 COPD patients were assessed both in the stable phase and during exacerbation. The median FEV1 for the stable phase and exacerbation were 61% predicted (interquartile range [IQR], 49 to 74% predicted) and 51% predicted (IQR, 45 to 60% predicted), respectively. The median decrease in FEV(1) with SI during an exacerbation was 0.27 L (IQR, 0.17 to 0.40 L) vs 0.28 L (IQR, 0.22 to 0.44 L) during the stable phase (p = 0.03). The patients experienced the associated dyspnea well; no other adverse events occurred. All FEV1 values returned to within 90% of their initial value within 30 min. A larger decrease in FEV1 due to SI during an exacerbation was associated with the following parameters in the stable phase of disease: lower total sputum cell count (r = -0.37; p = 0.01); higher percentage of eosinophils (r = 0.33; p = 0.04); and a larger decrease in FEV1 after SI (r = 0.39; p = 0.03). In a multivariate analysis, the only independent association was with the larger decrease in FEV1 in the stable phase. We concluded that SI can be safely carried out in patients with mild-to-moderate COPD who experience an exacerbation, and this occurs with no greater risk than in stable patients with COPD.
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Affiliation(s)
- Erik Bathoorn
- Department of Pulmonology, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, the Netherlands
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Tsoumakidou M, Papadopouli E, Tzanakis N, Siafakas NM. Airway inflammation and cellular stress in noneosinophilic atopic asthma. Chest 2006; 129:1194-202. [PMID: 16685009 DOI: 10.1378/chest.129.5.1194] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES It has been suggested that patients with noneosinophilic asthma (NEA) show increased numbers of sputum neutrophils and a lack of response to therapy with corticosteroids, which are features that are commonly related to COPD. The aim of our study was to test the hypothesis that airway inflammation in NEA patients is different from that seen in patients with eosinophilic asthma (EA) and is similar to COPD. DESIGN Sputum cellular stress markers and neutrophilic and eosinophilic fluid-phase mediators were analyzed in asthma and COPD patients. NEA patients were identified based on a sputum eosinophil count of < or = 2.2% of the total nonsquamous cell count, and were compared to EA and COPD patients. SETTING University Hospital of Heraklion, Department of Thoracic Medicine. PATIENTS A total of 37 atopic asthmatic patients and 25 patients with COPD. MEASUREMENTS Sputum cell counts, cellular expression of heme oxygenase-1, inducible nitric oxide synthase, and nitrotyrosine, and sputum levels of eosinophilic cationic protein (ECP), myeloperoxidase (MPO), interleukin-8, and granulocyte macrophage colony-stimulating factor. RESULTS A total of 17 asthmatic patients (46%) belonged to the NEA group and 20 patients (54%) to the EA group. Patients with NEA showed no difference in neutrophil counts, fluid-phase mediators, or cellular stress markers compared to patients with EA. Compared to COPD patients, NEA patients showed the following significant differences: lower total cell counts (p < 0.03); lower neutrophil counts (p < 0.01); lower nitrotyrosine positive cell counts (p < 0.003); lower ECP levels (p < 0.005); lower MPO levels (p < 0.000); higher lymphocyte counts (p < 0.01); and higher macrophage counts (p < 0.03). CONCLUSIONS Despite low eosinophil counts, airway inflammation in NEA patients may share common features with that in EA patients but is distinct from COPD. Larger studies are needed to investigate further the clinical and inflammatory characteristics of NEA before we are able to categorize asthma patients into those with or without eosinophilic inflammation.
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Affiliation(s)
- Maria Tsoumakidou
- Department of Thoracic Medicine, University of Crete, Medical School, PO Box 1352, 71110 Heraklion, Crete, Greece
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Abstract
Airway inflammation is central to the pathogenesis of both airway remodelling and parenchymal destruction in chronic obstructive pulmonary disease (COPD). Neutrophils, macrophages, and CD8+ T lymphocytes have been implicated in a number of studies, but a detailed profile of disease-phenotype specific inflammation has yet to emerge. The heterogeneity of the disease has hindered data interpretation while extrapolation of the results of relatively non-invasive studies to the actual pathology found in the distal lung is difficult. Moreover, prominent studies have had frequently conflicting results. Further investigations are needed to marry the different clinical phenotypes of COPD to their respective inflammatory profiles in the airways and thus improve our understanding of the pathogenesis of the disease as a whole.
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Affiliation(s)
- R O'Donnell
- Respiratory Cell and Molecular Biology, Division of Infection, Inflammation and Repair, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
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Belda J, Margarit G, Martínez C, Casan P, Rodríguez-Jerez F, Brufal M, Torrejón M, Granel C, Sanchis J. [Bronchial exudate of serum proteins during asthma attack]. Arch Bronconeumol 2005; 41:328-33. [PMID: 15989890 DOI: 10.1016/s1579-2129(06)60232-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although altered vascular permeability and edema of the bronchial mucosa are associated with asthma attack, their influence on its severity remains unknown. We address this issue by comparing relative indices for the concentration of albumin (RIAlb) and alpha2-macroglobulin (RIalpha2M) in induced sputum and peripheral blood from patients with exacerbated asthma, patients with stable asthma, and control subjects. PATIENTS AND METHODS Forty-six volunteers participated in the study: 14 with exacerbated asthma (forced expiratory volume in the first second [FEV1] 74.3% [SD, 20.8%] of reference), 23 with stable asthma (FEV1 93.6% [7.5%]), and 9 controls (FEV1 101.1% [9.9%]). The concentrations of albumin and alpha2-macroglobulin were quantified by immunoturbidimetry and immunonephelometry, respectively. The relative index was then calculated by dividing the concentration in sputum supernatant by the concentration in peripheral blood. RESULTS The mean RIAlb was 1.2 (1.1) in the control group, 2.9 (3.1) in the stable asthma group, and 6.0 (6.7) in the exacerbated asthma group. The RIalpha2M values were 11.7 (10.9), 11.9 (14.7), and 3.2 (3.8) for the control group and stable and exacerbated asthma groups, respectively. The increases in the RIAlb values between all groups, and the decrease in the RIalpha2M value between the exacerbated asthma and control groups were statistically significant (P<.05). The percentage of neutrophils, but not of eosinophils, in sputum was correlated with the RIAlb (r=0.39; P=.008) but not the RIalpha2M (r=-0.035; P=.82). FEV1 displayed an inverse relationship with the RIAlb (r=-0.43; P=.009) but not with the RIalpha2M (r=-0.206; P=.24). No correlation was found between oxyhemoglobin saturation and either the RIAlb (r=-0.33; P=.19) or the RIalpha2M (r=-0.12; P=.84). CONCLUSIONS Vascular permeability is altered during asthma exacerbations and appears to be correlated with the presence of neutrophils and the degree of bronchial obstruction.
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Affiliation(s)
- J Belda
- Clínica d'Asma i Allèrgia, Departament de Pneumologia, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Belda J, Margarit G, Martínez C, Casan P, Rodríguez-Jerez F, Brufal M, Torrejón M, Granel C, Sanchis J. Exudado bronquial de proteínas séricas en las crisis de asma. Arch Bronconeumol 2005. [DOI: 10.1157/13076001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Although the role of eosinophils, mast cells, and T cells in asthma has long been recognized, several reports suggest that neutrophils may also be involved. In most studies of people with mild asthma, neutrophil numbers in the airways are not different from controls. However, in severe asthma, including asthma deaths, neutrophils are usually raised. Furthermore, most pediatric studies suggest that neutrophils are raised in some children, in particular in the young or infantile wheeze group. Measurements of inflammatory mediators in the airways of asthmatic subjects suggest that neutrophils are activated.
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Affiliation(s)
- Madeleine Ennis
- Department of Clinical Biochemistry, Institute of Clinical Science, The Queen's University of Belfast, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland, UK.
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