Wong H H, Fahy J V
Department of Medicine, University of California, San Francisco 94143, USA.
Am J Respir Crit Care Med. 1997 Jul;156(1):299-303. doi: 10.1164/ajrccm.156.1.9610114.
To assess the safety of sputum induction in asthmatic subjects, we conducted a retrospective review of data from 351 sputum inductions in 78 subjects from our institution. The sputum induction protcol consisted of baseline FEV1, pretreatment with albuterol 180 micrograms, postbronchodilator spirometry 15 min later, the induction procedure itself (inhalation of 3% saline for 20 min), and postsputum induction spirometry. We found that sputum induction was usually well tolerated, although some subjects developed wheeze and dyspnea. Overall, 11 of the 78 subjects (14%) had a fall in FEV1 of > or = 20% from the postbronchodilator baseline ("excessive bronchoconstriction") during their first sputum induction (range: -20 to -69%); no subject developed refractory bronchoconstriction requiring hospitalization or emergency room treatment. Only one of the 54 subjects (1.9%) with a baseline prebronchodilator FEV1 > 80% had excessive bronchoconstriction, whereas 10 of the 24 subjects (42%) whose baseline FEV1 was < or = 80% predicted did so. The change in FEV1 during sputum induction was significantly correlated with the baseline prebronchodilator FEV1% predicted, the baseline postbronchodilator FEV1% predicted, the PC20 for methacholine, and the percentage of eosinophils in induced sputum. We conclude that 180 micrograms albuterol does not prevent excessive bronchoconstriction in all asthmatic subjects undergoing sputum induction, especially in asthmatic subjects with a low baseline FEV1. Pulmonary function should be monitored regularly during sputum induction in asthmatic subjects to monitor for excessive bronchoconstriction.
为评估哮喘患者痰液诱导的安全性，我们对本机构78例患者的351次痰液诱导数据进行了回顾性分析。痰液诱导方案包括基线第一秒用力呼气容积（FEV1）、180微克沙丁胺醇预处理、15分钟后支气管扩张剂后肺功能测定、诱导过程本身（吸入3%盐水20分钟）以及诱导后肺功能测定。我们发现，痰液诱导通常耐受性良好，尽管有些患者出现了喘息和呼吸困难。总体而言，78例患者中有11例（14%）在首次痰液诱导期间FEV1较支气管扩张剂后基线下降≥20%（“过度支气管收缩”）（范围：-20%至-69%）；没有患者出现需要住院或急诊治疗的难治性支气管收缩。支气管扩张剂前基线FEV1>80%的54例患者中只有1例（1.9%）出现过度支气管收缩，而基线FEV1≤预测值80%的24例患者中有10例（42%）出现过度支气管收缩。痰液诱导期间FEV1的变化与支气管扩张剂前基线预测FEV1%、支气管扩张剂后基线预测FEV1%、乙酰甲胆碱的PC20以及诱导痰液中嗜酸性粒细胞百分比显著相关。我们得出结论，180微克沙丁胺醇不能预防所有接受痰液诱导的哮喘患者出现过度支气管收缩，尤其是基线FEV1较低的哮喘患者。哮喘患者痰液诱导期间应定期监测肺功能，以监测是否出现过度支气管收缩。
