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      Sputum analysis in diagnosis and management of obstructive airway diseases

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          Abstract

          Induced sputum analysis has recently emerged as a potential new clinical tool in the diagnosis and management of obstructive airway diseases such as asthma, chronic obstructive pulmonary disease, and other disorders including bronchiectasis. Its safety has been demonstrated in numerous studies, and its efficacy is superior to previous techniques for determining airway inflammation. It is a noninvasive and highly reproducible approach in generating a measurable index of inflammatory cells in the airways of the lungs. Recent studies have shown that exacerbations, particularly in patients with moderate to severe asthma, can be reduced by routine analysis of induced sputum samples. We now have the ability to clinically apply sputum measurements to manage asthmatics. Inflammatory markers and cell types in induced sputum can also be investigated using newer technologies with more sensitive qualitative and quantitative features than basic cellular analysis. This review outlines the procedure for sputum induction, characterizes inflammatory cell types in the sputum, and addresses recent advances in the field of sputum analysis.

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          Most cited references 72

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          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

           ,  Suzanne Hurd,  P Calverley (2001)
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            Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial.

            Treatment decisions in asthma are based on assessments of symptoms and simple measures of lung function, which do not relate closely to underlying eosinophilic airway inflammation. We aimed to assess whether a management strategy that minimises eosinophilic inflammation reduces asthma exacerbations compared with a standard management strategy. We recruited 74 patients with moderate to severe asthma from hospital clinics and randomly allocated them to management either by standard British Thoracic Society asthma guidelines (BTS management group) or by normalisation of the induced sputum eosinophil count and reduction of symptoms (sputum management group). We assessed patients nine times over 12 months. The results were used to manage those in the sputum management group, but were not disclosed in the BTS group. The primary outcomes were the number of severe exacerbations and control of eosinophilic inflammation, measured by induced sputum eosinophil count. Analyses were by intention to treat. The sputum eosinophil count was 63% (95% CI 24-100) lower over 12 months in the sputum management group than in the BTS management group (p=0.002). Patients in the sputum management group had significantly fewer severe asthma exacerbations than did patients in the BTS management group (35 vs 109; p=0.01) and significantly fewer patients were admitted to hospital with asthma (one vs six, p=0.047). The average daily dose of inhaled or oral corticosteroids did not differ between the two groups. A treatment strategy directed at normalisation of the induced sputum eosinophil count reduces asthma exacerbations and admissions without the need for additional anti-inflammatory treatment.
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              Chronic obstructive pulmonary disease.

               Chris Barnes (2000)
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                September 2005
                September 2005
                : 1
                : 3
                : 169-179
                Affiliations
                Pulmonary Research Group, Department of Medicine, University of Alberta Edmonton, AB, Canada
                Author notes
                Correspondence: Paige Lacy 550A HMRC, Department of Medicine, University of Alberta, Edmonton, AB T6G 2S2, Canada Tel +1 780 492 6085 Fax +1 780 492 5329 Email paige.lacy@ 123456ualberta.ca
                Article
                1661627
                18360557
                © 2005 Dove Medical Press Limited. All rights reserved
                Categories
                Review

                Medicine

                asthma, cystic fibrosis, inflammation, chronic obstructive pulmonary disease, spirometry

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