Page 59 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 59
a consequence of airway impairment and Conclusion 59
impaired local defence caused by airway mu-
cosal damage in asthma28. Induced sputum is a valuable tool for deter- induced sputum role in severe asthma phenotyping
mining the asthma inflammatory pheno-
Induced sputum analysis in research types. Monitoring of airway inflammation
and clinical practice provide additional data which enables indi-
vidual adjustment of treatment to each pa-
Sputum induction analysis is non-invasive, tient. With the introduction of biological
but quite a technically demanding procedure. therapy, precise immunological phenotyping
Besides, it has safety concerns, as inhaled hy- becomes even more significant. For this rea-
pertonic saline can cause adverse effects such son, we would recommend that every severe
as coughing, vomiting, bronchoconstriction asthma center should be familiar with this
and lung hyperinflation29. The mechanism of method and its use in clinical practice.
the effect is unknown but may involve the ac-
tivation of airway mast cells or sensory nerve References
endings. This makes the examination uncom-
fortable for some patient, and monitoring of 1. Pin I, Gibson PG, Kolendowicz R, et al.
lung function during the procedure is nec- Use of induced sputum cell counts to in-
essary. The safety of the method was thor- vestigate airway inflammation in asth-
oughly assessed in patients with airway ob- ma. Thorax. 1992 Jan;47(1):25-9.
struction characteristic for asthma29,30 and
COPD31,32. Pretreatment with beta-agonists is 2. Pizzichini E, Pizzichini MM, Efthi-
a routine part of the procedure and is intend- miadis A, et al. Indices of airway in-
ed to prevent bronchospasm. In our practice flammation in induced sputum: repro-
some subjects reported adverse events, most- ducibility and validity of cell and flu-
ly dyspnea followed by drop in lung function, id-phase measurements. Am J Respir
but after bronchodilator and corticosteroid Crit Care Med. 1996 Aug;154(2 Pt
therapy all recovered. During the sputum in- 1):308-17.
duction procedure, the patient must be care-
fully monitored by the medical staff, patients 3. Fleming L, Tsartsali L, Wilson N, et al
should be encouraged to expectorate quality Longitudinal relationship between spu-
and sufficient sample for cytological analysis, tum eosinophils and exhaled nitric oxi-
for which the procedure is rather demanding de in children with asthma. Am J Respir
and complicated. That makes this procedure Crit Care Med. 2013 Aug 1;188(3):400-
time-consuming. For these reasons, it is per- 2.
formed only in specialized respiratory clinics
and as a part of research projects. 4. Wang F, He XY, Baines KJ, et al. Dif-
ferent inflammatory phenotypes in
Induced sputum analysis has brought adults and children with acute asthma.
new insights into innate and adaptive immu- Eur Respir J. 2011 Sep;38(3):567-74.
nity processes in airways, but did not answer
all questions33. It also allowed investigations 5. Paggiaro PL, Chanez P, Holz O, et al.
in transcriptomics, proteomics, and genom- Sputum induction. Eur Respir J Suppl.
ics, which are in progress, hoping to eluci- 2002 Sep:37:3s-8s.
date more about the complexity of inflamma-
tion34. 6. Szefler SJ, Wenzel S, Brown R, et al.
Asthma outcomes: biomarkers. J Aller-
gy Clin Immunol. 2012 Mar;129(3 Sup-
pl):S9-23.
7. Fahy JV, Wong H, Liu J, et al. Com-
parison of samples collected by spu-
tum induction and bronchoscopy
from asthmatic and from healthy sub-
impaired local defence caused by airway mu-
cosal damage in asthma28. Induced sputum is a valuable tool for deter- induced sputum role in severe asthma phenotyping
mining the asthma inflammatory pheno-
Induced sputum analysis in research types. Monitoring of airway inflammation
and clinical practice provide additional data which enables indi-
vidual adjustment of treatment to each pa-
Sputum induction analysis is non-invasive, tient. With the introduction of biological
but quite a technically demanding procedure. therapy, precise immunological phenotyping
Besides, it has safety concerns, as inhaled hy- becomes even more significant. For this rea-
pertonic saline can cause adverse effects such son, we would recommend that every severe
as coughing, vomiting, bronchoconstriction asthma center should be familiar with this
and lung hyperinflation29. The mechanism of method and its use in clinical practice.
the effect is unknown but may involve the ac-
tivation of airway mast cells or sensory nerve References
endings. This makes the examination uncom-
fortable for some patient, and monitoring of 1. Pin I, Gibson PG, Kolendowicz R, et al.
lung function during the procedure is nec- Use of induced sputum cell counts to in-
essary. The safety of the method was thor- vestigate airway inflammation in asth-
oughly assessed in patients with airway ob- ma. Thorax. 1992 Jan;47(1):25-9.
struction characteristic for asthma29,30 and
COPD31,32. Pretreatment with beta-agonists is 2. Pizzichini E, Pizzichini MM, Efthi-
a routine part of the procedure and is intend- miadis A, et al. Indices of airway in-
ed to prevent bronchospasm. In our practice flammation in induced sputum: repro-
some subjects reported adverse events, most- ducibility and validity of cell and flu-
ly dyspnea followed by drop in lung function, id-phase measurements. Am J Respir
but after bronchodilator and corticosteroid Crit Care Med. 1996 Aug;154(2 Pt
therapy all recovered. During the sputum in- 1):308-17.
duction procedure, the patient must be care-
fully monitored by the medical staff, patients 3. Fleming L, Tsartsali L, Wilson N, et al
should be encouraged to expectorate quality Longitudinal relationship between spu-
and sufficient sample for cytological analysis, tum eosinophils and exhaled nitric oxi-
for which the procedure is rather demanding de in children with asthma. Am J Respir
and complicated. That makes this procedure Crit Care Med. 2013 Aug 1;188(3):400-
time-consuming. For these reasons, it is per- 2.
formed only in specialized respiratory clinics
and as a part of research projects. 4. Wang F, He XY, Baines KJ, et al. Dif-
ferent inflammatory phenotypes in
Induced sputum analysis has brought adults and children with acute asthma.
new insights into innate and adaptive immu- Eur Respir J. 2011 Sep;38(3):567-74.
nity processes in airways, but did not answer
all questions33. It also allowed investigations 5. Paggiaro PL, Chanez P, Holz O, et al.
in transcriptomics, proteomics, and genom- Sputum induction. Eur Respir J Suppl.
ics, which are in progress, hoping to eluci- 2002 Sep:37:3s-8s.
date more about the complexity of inflamma-
tion34. 6. Szefler SJ, Wenzel S, Brown R, et al.
Asthma outcomes: biomarkers. J Aller-
gy Clin Immunol. 2012 Mar;129(3 Sup-
pl):S9-23.
7. Fahy JV, Wong H, Liu J, et al. Com-
parison of samples collected by spu-
tum induction and bronchoscopy
from asthmatic and from healthy sub-
