THE VALUE OF INDUCED SPUTUM IN THE DIAGNOSIS AND MANAGEMENT OF CHILDREN WITH BRONCHIAL ASTHMA

Background: Induced sputum in children with bronchial asthma represents a non-invasive method of bronchial inflammation assessment. The main objective of our study was to analyze the cellularity of sputum in patients with bronchial asthma according to the level of disease control and the controlling therapy (with/without inhaled glucocorticoids). The second objective was to establish the correlation between sputum cellularity and other indirect parameters used to evidence bronchial inflammation (exhaled nitric oxide) and obstruction (forced expiratory volume in 1 second).Methods: The study included children with bronchial asthma that were assessed clinically (physical exam, questionnaire on the control of bronchial asthma in children) and by medical tests (induced sputum, exhaled nitric oxide, spirometry).Results: In patients with partially controlled asthma and those with uncontrolled asthma, the eosinophils percentage in the sputum was higher than in patients with controlled asthma (19.8±26.4% respectively 9.2±20.5% versus 4.5±14.6%, p<0.001). Higher percentage of neutrophils in the sputum was found in the partially controlled and uncontrolled asthma than in the controlled asthma (43.9±20.1% respectively 51.6±38.3% versus 35±19.7%, p=0.009). We also evidenced a direct and statistically significant correlation between the exhaled nitric oxide and the neutrophils percentage in the sputum (r=0.67, p=0.0003). Also, an indirect, moderate to good correlation (r=-0.56, p=0.005) was evidenced between the values of the forced expiratory volume in 1 second and the high eosinophils percentage in the sputum.Conclusions: In partially controlled and uncontrolled bronchial asthma the eosinophils and neutrophils count in the sputum is significantly higher than in patients with controlled asthma. There is an indirect correlation between the high eosinophils count in the sputum and the forced expiratory volume in 1 second, as well as a direct correlation between the neutrophils count and the exhaled nitric oxide, suggesting that induced sputum should be used in combination with other indirect parameters for the evidence of bronchial inflammation.

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Correlation between exhaled nitric oxide, sputum eosinophils, and methacholine responsiveness in patients with mild asthma.

Thorax ◽

10.1136/thx.53.2.91 ◽

1998 ◽

Vol 53 (2) ◽

pp. 91-95 ◽

Cited By ~ 449

Author(s):

A Jatakanon ◽

S Lim ◽

S A Kharitonov ◽

K F Chung ◽

P J Barnes

Keyword(s):

Nitric Oxide ◽

Airway Inflammation ◽

Exhaled Nitric Oxide ◽

Induced Sputum ◽

Sputum Induction ◽

Asthmatic Patients ◽

Inhaled Steroids ◽

Non Invasive ◽

Exhaled No ◽

Sputum Eosinophils

BACKGROUND: Eosinophils in induced sputum and exhaled nitric oxide (NO) are currently used as non-invasive markers in the assessment of airway inflammation in asthma. As both sputum eosinophils (%) and exhaled NO are raised in asthmatic subjects not receiving inhaled steroids and decreased following corticosteroid therapy, a relationship between them is plausible. METHODS: Exhaled NO was measured by chemiluminescence analyser, sputum induction by 3.5% saline inhalation, and bronchial responsiveness was measured as PC20FEV1 methacholine in 35 stable asthmatic patients using beta 2 agonist alone and the correlation between these non-invasive markers of airway inflammation was studied. RESULTS: There were significant correlations between exhaled NO and PC20 (r = -0.64), exhaled NO and sputum eosinophils (%) (r = 0.48), and also between sputum eosinophils (%) and PC20 (r = -0.40). CONCLUSION: The correlation between exhaled NO and PC20 suggests that exhaled NO or the mechanisms leading to its increase may contribute to airway hyperresponsiveness in asthma. Furthermore, the relationship between sputum eosinophils (%), exhaled NO, and PC20 highlight the potential use of eosinophils (%) in induced sputum and exhaled NO to monitor the severity of asthma.

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Monitoring the Fractional Concentration of Exhaled Nitric Oxide (FENO) in Uncontrolled Asthma Before and After Steroid Therapy Using a New Portable Monitor

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2006.11.374 ◽

2007 ◽

Vol 119 (1) ◽

pp. S89

Author(s):

W.E. Berger

Keyword(s):

Nitric Oxide ◽

Steroid Therapy ◽

Exhaled Nitric Oxide ◽

Uncontrolled Asthma ◽

Portable Monitor ◽

Fractional Concentration ◽

Before And After

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Exhaled nitric oxide, induced sputum and exhaled breath analysis

Paediatric Respiratory Medicine ◽

10.1183/9781849840392.026712 ◽

2013 ◽

pp. 100-106

Author(s):

Johan C. de Jongste

Keyword(s):

Nitric Oxide ◽

Breath Analysis ◽

Exhaled Nitric Oxide ◽

Induced Sputum ◽

Exhaled Breath ◽

Exhaled Breath Analysis

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Correlation study of cytokine levels in alveolar lavage fluid with exhaled nitric oxide and lung function in children with bronchial asthma

Translational Pediatrics ◽

10.21037/tp-21-322 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Ying Lou ◽

Qiuping Ke ◽

Huailiang Cui ◽

Ying Shang ◽

Chengsheng Yang

Keyword(s):

Nitric Oxide ◽

Lung Function ◽

Bronchial Asthma ◽

Lavage Fluid ◽

Correlation Study ◽

Exhaled Nitric Oxide ◽

Cytokine Levels

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The Utility of Serum IL-1β and CRP Together with Fractional Exhaled Nitric Oxide in the Diagnosis of Asthma in Adults

NeuroQuantology ◽

10.14704/nq.2021.19.8.nq21122 ◽

2021 ◽

Vol 19 (8) ◽

pp. 119-124

Author(s):

Hayder Abdul-Amir Makki Al-Hindy ◽

Ali Jihad Hemid Al-Athari ◽

Mazin J. Mousa ◽

Safa Jihad Hameed ◽

Suhad Hafidh Obeed

Keyword(s):

Nitric Oxide ◽

Sensitivity And Specificity ◽

Bronchial Asthma ◽

High Sensitivity ◽

Exhaled Nitric Oxide ◽

Fractional Exhaled Nitric Oxide ◽

Asthmatic Patients ◽

Significant Difference ◽

Asthma Patients ◽

Hs Crp

Background: Bronchial asthma (BrA), recognized lately as an umbrella, covers various subtypes rather than only one disease. Asthma is a chronic inflammation of the airways, in which cytokines could play a crucial role in its pathogenesis. Hence, labors to progress noninvasive markers for asthma had centered through this era. Presently, the fractional exhaled nitric oxide (FeNO), serum C-reactive protein (CRP), and interleukin levels are emerging analytical biomarkers in this field. FeNO is a noninvasive and practical tool even in mild asthma. This study aimed to evaluate the utility of serum IL-1β and CRP together with fractional exhaled nitric oxide in the diagnosis of adult bronchial asthma. Method: The study was a case control, including 150-patients and 100-healthy controls. FeNO tests, measurements of plasma levels IL-1β and HS-CRP had undertaken for all the participants. The statistical data had examined by SPSS (V/27) for Windows. Descriptive data of the variables had compatibly used. A significance lower than or identical to 0.05 had intended. ROC curve examination of FeNO tests, IL-1β, and HS-CRP, to predict asthma from healthy control had applied. Results: there was a significant difference in the FeNo test, HS-CRP levels, and BMI, while no significant difference in all other variables between the groups. The FeNo results correlate positively, though not significantly, with the levels of IL-1β in asthmatic patients (> 0.05). There was a nonsignificant negative correlation between the FeNo results with the level of HSCRP. The accuracy, sensitivity, and specificity of the IL-1β to distinguish asthma were 68.6% and 58% at 95% CI [0.41-0.745], respectively, which was not significant (p>0.05). However, ROC analysis of HS-CRP revealed predictability for asthma patients (p-0.000), with higher accuracy, sensitivity, and specificity: 89.9%, and 68.1% at 95% CI [0.820-0.979], respectively. The FeNo tests revealed highly significant (0.000), high sensitivity, and specific (91% for both) with high 95% CI [0.938-1.000] predictability for asthma. Conclusion: The utility of circulating HS-CRP is more valuable than IL-1β when combined with fractional exhaled nitric oxide in the diagnosis of asthma. Novel biomarkers could improve the precision of this field.

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