Assessment and reproducibility of non-eosinophilic asthma using induced sputum.

BACKGROUND

The assessment of eosinophilic airway inflammation using induced sputum identifies a corticosteroid-responsive subtype that can be used to guide anti-inflammatory therapy. The stability of airway inflammation in asthma over time is not known, yet this information is crucial to inflammation-based patient management.

OBJECTIVE

The aim of this study was to determine the reproducibility of non-eosinophilic asthma.

METHODS

Participants with stable asthma (n = 26) underwent a sputum induction each month for 5 months. Sputum was dispersed and differential cell counts were performed. The reproducibility of inflammatory subtype with different eosinophil cut points (starting at 1% eosinophils) was examined and the minimum number of visits required to determine inflammatory subtype was calculated.

RESULTS

One hundred and twenty- two sputum samples were obtained (success 94%). All cut points greater than 2% eosinophils were reproducible and a 3% cut point resulted in the highest agreement with a kappa statistic of 0.538. Specificity and sensitivity were high for determining inflammatory subtype after 1 or 3 sputum samples.

CONCLUSIONS

A cut point of 3% eosinophils should be used to distinguish eosinophilic from non-eosinophilic airway inflammation in asthma. This allows a single sputum sample to be used to reliably determine the presence of eosinophilia.