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Category: Volume 08 Issue 12 December 2020
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Title: Role of Induced Sputum to Assess Airway Inflammation in Asthma - Study from a Tertiary Care Centre

Authors: Dr Niyas K. Naseer, Dr Manoj, D.K, Dr Rajani.M, Dr Muhammed Shafeek, Dr Padmanabhan.K.V

 DOI: https://dx.doi.org/10.18535/jmscr/v8i12.11

Abstract

Asthma is a serious global health issue affecting all age groups. Asthmatics are usually assessed by spirometry, which means the physiologic impairment. But their hall mark is airway inflammation, which is rarely assessed. Airway inflammation has been studied widely in patients with chronic asthma, and it is seen that it correlates with the severity of the disease. The objective of this study  was to assess  the use of induced sputum  cytology  to classify  asthmatics  as neutrophil & eosinophil predominant , and to study the relationship of level of control, severity  of obstruction and their response to inhaled steroids in  asthmatics with the inflammatory subtypes in  stable asthmatic patients.

Methods: A total of 80 asthmatics who attend the outpatient clinic at the department of respiratory medicine, govt medical college Kannur, who met the inclusion & exclusion criteria were taken for the study. Initially history was taken and spirometry done and graded according to severity and then sputum induction done with 3% saline. Sputum processed and diffentiated into neutrophil, eosinophil or mixed/ paucigranulocyte type. A comparative study was done and patients were treated with inhaled corticosteroid for 2 weeks and their response were evaluated.

Result: Out of total 80 patients 60% were females. 18.8% were uncontrolled & 40% were well controlled. 21 patients had a neutrophil predominant picture, 44 had eosinophil predominant&6 had mixed picture. There was significant association between sputum phenotype & level of control, showing predominant neutrophil in uncontrolled. The response to inhaled steroid showed a significant improvement with eosinophilic phenotype.

Conclusion: Sputum induction can be used as an important noninvasive measurement of airway inflammation, in the diagnosis and management of asthma. It can also be used to assess the type of airway inflammation in asthmatic patients who were not controlled by asthma management.

Keywords: Sputum Induction, Airway Inflammation, Sputum Cytology.

References

  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Murphy DO'Byrne P. Recent Advances in the Pathophysiology of Chest.2010;137(6):1417-1426.
  2. Bousquet, P.K. Jeffery, W.W. Busse, et al, Asthma. From broncho constriction to airways inflammation and remodeling, Am. J. Respir. Crit.  Care Med. 161 (2000)1720–1745.
  3. Kirby JG, Hargreave FE, Gleich GJ, O'Byrne PM. Bronchoalveolar cell profiles of asthmatic and non asthmatic subjects. Am Rev Respir Dis1987;136:379-83.
  4. Wardlaw AJ, Dunnette S, Gleich GJ, Collins JV, Kay AB. Eosinophils and mast cells in bronchoalveolar lavage in subjects with mild asthma. Relationship to bronchial hyperreactivity. Am Rev Respir Dis1988;137:62-9.
  5. Gibson PG, Girgis-Gabardo A, Morris MM, Mattoli S, Kay JM, Dolovich J, et al. Cellular characteristics of sputum from patients with asthma and  chronic bronchitis. Thorax1989;44:689-92.
  6. Pizzichini, M.M. Pizzichini, A. Efthimiadis, Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluidphase measurements, Am. J. Respir. Crit. Care Med. 154 (1996)308–317.
  7. Bhowmik, T.A.R. Seemungal, R.J. Sapsford, J.L. Devalia, J.A. Wedzicha, Comparison of spontaneous and induced sputum for investigation of airway inflammation in chronic obstructive pulmonary disease, Thorax 53 (1998) 953– 956.
  8. T. de la Fuente, M. Romagnoli, P. Godard, J. Bousquet, P. Chanez, Safety of inducing sputum in patients with asthma of varying severity, Am. J. Respir. Crit. Care Med. 157 (1998)1127–1130.
  9. H. Green, C.E. Brightling, S. McKenna, B. Hargadon, D. Parker, P. Bradding,    et al, Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial, Lancet 360 (2002)1715–1721.
  10. G. Gibson, J.L. Simpson, N. Saltos, Heterogeneity of airway inflammation in persistent asthma: evidence of neutrophilic inflammation and increased sputum interleukin-8, Chest 119 (2001)1329–1336.
  11. Bacci, S. Chinchetti, M.L. Bartoli, et al, Low sputum eosinophils predict the lack of response to beclamethasone in symptomatic asthmatic patients, Chest 129 (2006)165–172.
  12. D. Pavord, C.D. Brightling, G. Woltmann, A.J. Wardlaw, Non-eosinophilic corticosteroid unresponsive asthma, Lancet 353 (1999)2213–2214.
  13. Cockcroft DW, McParland CP, Britto SA, Swystun VA, Rutherford BC. Regular inhaled salbutamol and airway responsiveness to allergen. Lancet 1993; 342 (8875):833–7.
  14. Pavord ID, Pizzichini MM, Hargreve FE. The use ofinduced sputum to investigate airway infiammation. Thorax 1997, 52: 498-502.
  15. Al Zahrani K, Al Jahdali H, Poirier L, Rene P, Menzies D. Yield of smear, culture and amplification tests from repeated sputum induction for the diagnosis of pulmonary tuberculosis. In t J Tubercule Lung Dis 2001; 5:855-60
  16. Hunter CI, Ward R, Woltmann G, Wardlaw AJ, Pavord ID. The safety and success rate of sputum induction using a low output ultrasonic nebuliser. Respir Med  1999; 93:345-8.
  17. Jones PD, Hankin R, Simpson 1, Gibson PG, Henry The tolerability, safety and success of sputum induction and combined hypertonic saline challenge in children. Am 1 RespirCrit Care Med 2001; 164:1146-9
  18. Wenzel SE. Phenotypes in asthma: useful guides for therapy, distinct biological processes, or both? Am    J    RespirCrit    Care    Med    2004;170: 579–580.
  19. L. Simpson, R.J. Scott, M.J. Boyle, P.G. Gibson, Inflammatory subtypes in asthma: assessment and identification using induced sputum, Respirology 11 (1) (2006)54–61.
  20. E. Shaw, M.A. Berry, B. Hargadon, S. McKenna, M.J. Shelley, R.H. Green, C.E. Brightling, A.J. Wardlaw, I.D. Pavord, Association between neutrophilic airway inflammation and airflow limitation in adults with asthma,  Chest  132 (2007)1871–1875
  21. Douwes, P. Gibson, J. Pekkanen, N. Pearce, Noneosinophilic asthma: importance and possible mechanisms, Thorax 57(2002)643–648.
  22. M. Li, T.W.T. Tsang, D.F.Y. Chan, et al, Cough frequency in  children  with  mild asthma correlates with sputum neutrophil count, Thorax 61(2006) 747–750.
  23. Stapleton M, Howard-Thompson A, George C, Hoover RM, Self TH (2011). "Smoking and asthma". J Am Board Fam Med. 24 (3): 313–22. doi:10.3122/jabfm.2011.03.100180. PMID 21551404
  24. G. Woodruff, R. Khashayar, S.C. Lazarus, et al, Relationship between airway inflammation, hyper responsiveness, and obstruction in asthma, J Allergy Clin. Immunol. 108 (5) (2001) 753–758.
  25. Elbehidy, D. Youssef, H. Salah, Asthma inflammatory subtype specific treatment; A randomized clinical study, EJB 4 (2010) 19–27, No. 1.
  26. Peleman, P. Rytila, J. Kips, et al, The cellular composition of induced sputum in chronic obstructive pulmonary disease, Eur. Respir. J. 13 (1999) 839–84362 (Thomson et al., 2004
  27. D. Pavord, C.D. Brightling, G. Woltmann, A.J. Wardlaw, Non-eosinophilic corticosteroid unresponsive asthma, Lancet 353 (1999) 2213–2214.
  28. C,E Brightling, Clinical application  of induced sputum, Chest 129(2006) 1344- 1348.
  29. Green RH, Brightling CE, Woltmann G, Parker D, Wardlaw AJ, Pavord ID. Analysis of induced sputum in adults with asthma: identification of subgroup with isolated sputum neutrophilia and poor response to inhaled corticosteroids. Thorax 2002;57(10):875–9.
  30. V.F AHY, Eosinophilic and neutrophilic inflammation in asthma. Insights from clinical studies  , Proc. Am Thoac.6(200)  256- 259
  31. Green RH, Brightling CE, McKenna S, Hargadon B, Parker D, Bradding P, Wardlaw AJ, Pavord ID. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet 2002;360(9347):1715–21.

Corresponding Author

Dr Rajani. M

Professor, Department of Respiratory Medicine, Govt Medical College, Kannur