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Thorax 2000;55:768-774 ( September )

Induced sputum in children: feasibility, repeatability, and relation of findings to asthma severity

Nicola M Wilsona, Peter Bridgea, Antonio Spanevellob, Michael Silvermana

a Department of Paediatrics, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK, b Division of Thoracic Medicine

Correspondence to: Dr N M Wilson, Department of Paediatrics, Royal Brompton and Harefield NHS Trust, London SW3 6NP, UK email: n.wilson{at}rbh.nthames.nhs.uk

Received 29 October 1999; Returned to authors 31 January 2000; Revised version received 30 May 2000; Accepted for publication 1 June 2000

BACKGROUND---The collection of induced sputum provides a non-invasive method of investigating airway inflammation. Few studies have been performed in children, so a study was undertaken to determine the feasibility of sputum induction, the repeatability of eosinophil counts and sputum eosinophil cationic protein (ECP) levels, and the relation of these to current asthma severity. For comparison, serum ECP levels were also measured.
METHODS---In a cross sectional study of children aged 5-15 years, 27 healthy children and 60 with asthma underwent sputum induction using inhaled nebulised hypertonic saline. The whole sputum sample was used for analysis. Ten children with stable asthma repeated the procedure within 10 days.
RESULTS---A satisfactory sample (>500 non-squamous cells) was obtained in 61% of children with asthma and in 60% of healthy controls. The limits of agreement within subjects ranged from a 0.68 to 2.8 fold difference for eosinophil differential counts and from 0.38 to 4.4 fold for sputum ECP. Despite a median of 42% squamous cells, significant differences were found between asthma and healthy controls for the eosinophil differential count (p = 0.0004), total eosinophil counts (p = 0.03), and sputum ECP level (p = 0.0001). Overall, there was no correlation between any marker of airway inflammation and asthma severity, however expressed, including lung function.
CONCLUSIONS---Sputum induction is only possible in a proportion of children. The repeatability of sputum cell counts and ECP levels, measured in a small number of children, was similar to that reported in adults. Sputum analysis revealed no evidence of airway inflammation in a number of highly symptomatic children with asthma.


Keywords: asthma; sputum; children

© 2000 by Thorax


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