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a Department of
Medicine, Division of Pulmonary and Critical Care, Stanford University,
Stanford, California, USA, b Department of Medicine, Division of Pulmonary
and Critical Care, University of Washington, Seattle, Washington, USA, c Department of Pediatrics, Division of Infectious
Disease Children's Hospital and Regional Medical Center, Seattle,
Washington, USA
Correspondence to: Dr M L Aitken, Division of Pulmonary and Critical Care Medicine, Box 356522, 1959 NE Pacific Street, Room BB1253, Seattle, WA 98195-6522, USA moira{at}u.washington.edu
Received 16 June 2000; Returned to authors 21 September 2000; Revised version received 8 November 2000; Accepted for publication 5 January 2001
BACKGROUND
Sputum
induction (SI) has proved to be a reliable non-invasive tool for
sampling inflammatory airway contents in asthma, with distinct
advantages over collection of expectorated sputum (ES) and
bronchoalveolar lavage (BAL). A study was undertaken to evaluate the
safety of SI and to assess if it might be an equally valuable outcome
tool in patients with cystic fibrosis (CF).
METHODSThe safety of
the procedure was examined and sample volume, cell counts, cytokine
concentrations, and bacterial culture results obtained by SI,
spontaneous ES, and fibreoptic bronchoscopy were compared in 10 adults
with CF.
RESULTSSI was well
tolerated and was preferred to BAL by all subjects. The mean (SE)
sample volume obtained by SI was significantly greater than ES (6.74 (1.46) ml v 1.85 (0.33) ml, p = 0.005). There was no significant difference in the number of cells per ml of
sample collected. There was a difference in the mean (SD) percentage of
non-epithelial, non-squamous cells collected (67 (28)%, 86 (21)%, and
99 (1)% for ES, SI, and BAL, respectively). These percentage counts
were different between ES and both SI and BAL (p=0.03 and p=0.006,
respectively). Cell differential counts (excluding squamous cells) from
all collection methods were similar (mean (SD) 84 (9)%, 87 (7)%, and
88 (11)% polymorphonuclear cells for ES, SI, and BAL, respectively).
The concentrations of interleukin (IL)-8 and tumour necrosis factor
(TNF)-
were the same in all three samples when corrected for
dilution using urea concentration. The test specific detection rate for
recovery of bacteriological pathogens was 79% for SI, 76% for ES, and
73% for BAL.
CONCLUSIONSI offers
safety advantages over BAL and may be a more representative airway
outcome measurement in patients with CF.
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