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Academic Department of Respiratory
Medicine, St Bartholomew's and Royal London School of Medicine and
Dentistry, London Chest Hospital, London E2 9JX, UK
Correspondence to: Dr J A Wedzicha.
Received 9 March 1998; Returned to authors 7 May 1998; Revised version received 30 June 1998; Accepted for publication 30 June 1998
BACKGROUND
Although sputum induction
is used as a technique to investigate lower airway inflammation in
asthmatic subjects, advantages over spontaneous sputum in patients with
chronic obstructive pulmonary disease (COPD) have not been investigated.
METHODSSamples of spontaneous sputum and sputum
induced with 3% hypertonic saline for 14 minutes were collected from
27 patients with chronic obstructive pulmonary disease (COPD) who
usually produced spontaneous sputum. Spirometric indices and oxygen
saturation (SaO2) were measured at seven minute
intervals. The spontaneous, seven and 14 minute sputum samples were
analysed for total and differential cell counts, cell viability, and
interleukin 8 levels.
RESULTSAnalysis of the sputum revealed
that median cell viability was higher in the seven minute (62.8%; p = 0.004) and 14 minute (65%; p = 0.001) induced sputum samples than in
spontaneous sputum (41.2%). There was no significant difference in
total and differential cell counts or in interleukin 8 levels between
spontaneous and induced sputum. During the sputum induction procedure
the mean (SD) fall in forced expiratory volume in one second
(FEV1) was 0.098 (0.111) l (p < 0.001) and in forced vital
capacity (FVC) was 0.247 (0.233) l (p < 0.001). There was a small but
significant fall in SaO2 during sputum
induction (p = 0.03).
CONCLUSIONSInduced sputum contains a
higher proportion of viable cells than spontaneous sputum. There are no
significant differences between the sputum samples obtained at seven
minutes and at 14 minutes of hypertonic saline nebulisation. Sputum
induction is safe and well tolerated in patients with COPD.
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