Hunter C J, Ward R, Woltmann G, Wardlaw A J, Pavord I D
Department of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital NHS Trust, Leicester, U.K.
Respir Med. 1999 May;93(5):345-8. doi: 10.1016/s0954-6111(99)90317-7.
Induced sputum differential cell counts have been advocated as a method of non-invasively assessing airway inflammation in asthma and other airway diseases. Since sputum induction usually involves delivering hypertonic saline via a high output ultrasonic nebulizer there have been concerns about its safety in asthma. There are relatively little data on the effects of sputum induction in large numbers of patients. We have examined the success rate and effect of sputum induction on forced expiratory volume in 1 sec (FEV1) in 100 inductions performed on 79 patients using a low output nebulizer. Thirty-seven patients had asthma, 29 had miscellaneous conditions (mainly chronic cough) and 13 were subjects without respiratory symptoms. Sputum was induced 10 min after 200 micrograms of inhaled salbutamol by sequential 5-min inhalations of 3, 4 and 5% saline delivered via a Fisoneb ultrasonic nebulizer and FEV1 was measured after each inhalation. Sputum induction resulted in a sample suitable for analysis in 92% of asthmatics, 90% of those with miscellaneous conditions and 100% of normal subjects. The mean (SEM) maximum per cent fall in FEV1 was 5.4% (0.1), 4.3%, (1.0) and 2.6% (1.1) in subjects with asthma, miscellaneous conditions and in asymptomatic subjects respectively. Only 13 inductions resulted in a > 10% fall in FEV1, and only three of these resulted in a > 20% fall. The maximum per cent fall in FEV1 did not correlate with baseline FEV1 % predicted (r = -0.17), the log sputum eosinophil count (r = -0.12), or the methacholine PC20 (r = -0.14). We conclude that sputum induction using a relatively low output ultrasonic nebulizer with premedication with salbutamol is successful and safe in the majority of patients with asthma and other airway conditions.
诱导痰细胞分类计数已被推荐作为一种非侵入性评估哮喘和其他气道疾病气道炎症的方法。由于痰液诱导通常涉及通过高输出超声雾化器输送高渗盐水，因此人们对其在哮喘中的安全性存在担忧。关于大量患者痰液诱导效果的数据相对较少。我们使用低输出雾化器对79例患者进行了100次诱导，研究了痰液诱导的成功率及其对一秒用力呼气容积（FEV1）的影响。37例患者患有哮喘，29例患有其他病症（主要是慢性咳嗽），13例为无呼吸道症状的受试者。在吸入200微克沙丁胺醇10分钟后，通过Fisoneb超声雾化器依次5分钟吸入3%、4%和5%的盐水诱导痰液，并在每次吸入后测量FEV1。痰液诱导在92%的哮喘患者、90%的其他病症患者和100%的正常受试者中获得了适合分析的样本。哮喘患者、其他病症患者和无症状受试者FEV1的平均（SEM）最大下降百分比分别为5.4%（0.1）、4.3%（1.0）和2.6%（1.1）。只有13次诱导导致FEV1下降>10%，其中只有3次导致下降>20%。FEV1的最大下降百分比与预测的基线FEV1%（r = -0.17）、痰液嗜酸性粒细胞计数对数（r = -0.12）或乙酰甲胆碱PC20（r = -0.14）均无相关性。我们得出结论，使用相对低输出的超声雾化器并预先使用沙丁胺醇进行痰液诱导，在大多数哮喘和其他气道疾病患者中是成功且安全的。
