[en] INTRODUCTION: The technique of induced expectoration generates sputum by the inhalation of hypertonic saline. On account of its non-invasive character, its simplicity, its relative harmlessness, its cost effectiveness and its reproducibility this technique, that appeared in the early 1990's, has rapidly established itself as the technique of choice in the investigation of bronchial inflammation in asthma. STATE OF THE ART: We present the results of our studies that have contributed to the validation of the technique at the methodological level and to the exploitation of the cellular contents as much as the fluid phase of the expectorations in characterising bronchial inflammation in asthmatics. Our results confirm an infiltration of the airways of asthmatics with eosinophils that appears to be proportional to the severity of the illness. We evaluate the effect of inhaled steroids and of theophylline on sputum eosinophilia and bronchial reactivity and discuss the role of eosinophils on bronchial hyperreactivity. Finally we discuss the use of induced expectoration in clinical practice in asthma. PERSPECTIVES: The analysis of induced sputum could well become a valuable tool in the clinical evaluation and monitoring of asthma in the same way as symptoms and abnormalities of lung function. CONCLUSIONS: Induced expectoration has certainly contributed to the understanding of the cellular and molecular mechanisms of asthma as well as the role of bronchial inflammation in the clinical manifestations of the disease.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Louis, Renaud ; Centre Hospitalier Universitaire de Liège - CHU > Pneumologie-Allergologie
Bettiol, Jane
Cataldo, Didier ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et path.
Bureau, Fabrice ; Université de Liège - ULiège > Département de sciences fonctionnelles > GIGA-R : Biochimie et biologie moléculaire
Seumois, G.
Radermecker, Maurice ; Centre Hospitalier Universitaire de Liège - CHU > Pneumologie-Allergologie
Bartsch, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Pneumologie-Allergologie
Djukanovic, R.
Language :
French
Title :
Interet des expectorations induites dans l'exploration de l'asthme.
Alternative titles :
[en] Value of induced sputum in the investigation of asthma
Djukanovic R, Roche WR, Wilson JW, Beasley C, Twentyman O, Howarth P, Holgate S: Mucosal inflammation in asthma. Am Rev Respir Dis 1990; 142: 434-57.
Pin I, Gibson P, Kolendowicz R, Girgis-Gabardo A, Denburg J, Hargreave F, Dolovich J: Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax 1992; 47: 25-9.
Louis R, Shute J, Biagi S, Stanciu L, Marelli F, Tenor H, Hidi R, Djukanovic R: Cell infiltration, ICAM-1 expression, and eosinophil chemotactic activity in asthmatic sputum. Am J Respir Crit Care Med 1997; 155: 466-72.
Holz O, Jörres RA, Koschyk S, Speckin P, Welker L, Magnussen H: Changes in sputum composition during sputum induction in healthy and asthmatic subjects. Clin Exp Allergy 1998; 28: 284-92.
Wong H, Fahy JV: Safety of one method of sputum induction in asthmatic subjects. Am J Respir Crit Care Med 1997; 156: 299-303.
Delafuente P, Romagnoli M, Godard P, Bousquet J, Chanez P: Safety of inducing sputum in patients with asthma of varying severity. Am J respir Crit Care Med 1998; 157: 1127-30.
Cataldo D, Foidart JM, Lau L, Bartsch P, Djukanovic R, Louis R: Induced sputum: comparison between isotonic and hypertonic saline in asthma. Chest 2001; 120: 1815-21.
Louis R, Shute J, Goldring K, Perks B, Lau L, Radermecker M, Djukanovic R: The effect of processing on inflammatory markers in induced sputum. Eur Respir J 1999; 13: 660-7.
Keatings V, Barnes P: Differences in interleukin-8 and Tumor Necrosis factor-a in induced sputum from patients with chronic obstructive pulmonary disease or asthma. Am J Respir Crit Care Med 1996; 153: 530-4.
Kono S, Gonokami Y, Kurokawa M, Kawazu, Asano K, Okamoto K, Adachi M: Cytokine concentrations in sputum of asthmatic patients. Int Arch Allergy Immunol 1996; 109: 73-8.
Louis R, Sele J, Henket M, Cataldo D, Bettiol J, Bartsch P: Sputum eosinophil counts in a large population of mild to moderate steroid naive asthmatics: distribution and relationship with methacholine bronchial hyperresponsiveness. Allergy 2002; 57: 907-12.
Bousquet J, Chanez P, Lacoste J, Barneon G, Chavanian N, Enander I, Venge P, Alhstedt S, Simony-1Lafontaine, Godard F, Michel F: Eosinophilic inflammation in asthma. New Engl J Med 1990; 323: 1033-9.
Kay AB: Allergy and allergic diseases: Part I. New Engl J Med 2001; 344: 30-7.
Johnston S, Pattermore P, Sanderson G, Smith S, Lampe F, Josephs L, Symington P, Toole S, Mynt S, Tyrell D, Holgate S: Community study of rôle of viral infections in exacerbations of asthma in 9-11 year old children. Brit Med J 1995; 310: 1225-8.
Kidney J, Wong AJ, Efthimiadis A, Morris M, Sears M, Dolovich J, Hargreave F: Elevated B cells in sputum of asthmatics. Close correlation with eosinophils. Am J Respir Crit Care Med 1996; 153: 540-4.
Bettiol J, Radermecker M, Sele J, Henket M, Cataldo D, Louis R: Airway mast cell activation in asthmatics is associated with selective sputum eosinophilia. Allergy 1999; 54: 1118-93.
Bettiol J, Sele J, Henket M, Louis E, Malaise M, Bartsch P, Louis R: Cytokine production from sputum cells after allergenic challenge in atopic asthmatics. Allergy 2002; 57: 1145-50.
Cataldo D, Munaut C, Noel A, Frankenne F, Bartsch P, Fopidart JM, Louis R: MMP-2 and MMP-9-linked gelatinolytic activity in the sputum from patients with asthma and chronic obstructive pulmonary disease. Int Arch Allergy Immunol 2000; 123: 259-67.
Cataldo D, Bettiol J, Foidart JM, Noël A, Bartsch P, Louis R: MMP-9, but not TIMP-1, increases in sputum from asthmatics after allergen challenge. Chest 2002; 122: 1553-9.
Bousquet J, Chanez P, Lacoste J et coll.: Asthma: a disease remodelling the airways. Allergy 1992; 47: 3-11.
Bettiol J, Degroote D, Gevaerts Y, Louis E, Malaise M, Bartsch P, Louis R: Cytokine production from peripheral whole blood in atopic and non atopic asthmatics: relationship with blood and sputum eosinophilia and serum IgE levels. Allergy 2000; 55: 1134-41.
Adachi T, Moijima S, Hirata A, Fukuda T, Makino S: Eosinophil viability-enhancing activity in sputum patients with bronchial asthma. Contributions of interleukin-5 and granulocyte/macrophage colonystimulating factor. Am J Respir Crit Care Med 1995; 151: 618-23.
Louis R, Cataldo D, Buckley M, Sele J, Henket M, Bartsch P, Djukanovic R: Evidence of mast cell activation in a subset of patients with eosinophil chronic obstructive lung disease. Eur Respir J 2002; 20: 325-31.
Louis R, Bettiol J, Cataldo D, Sele J, Henket M, Radermecker M: Effect of a 4 week treatment with theophylline on sputum eosinophilia and sputum eosinophil chemotactic activity in steroid naive asthmatics. Clin Exp Allergy 2000; 1151-60.
Louis R, Shute J, Quaden C, Cataldo D, Radermecker M, Djukanovic R: Effect of inhaled corticosteroids on sputum eosinophil counts and sputum eosinophil chemotactic factors in mild to moderate steroid naive asthmatics. Eur Respir J 1998; 12, Suppl 28: 437s.
Wooley K, Gibson P, Carty K, Wilson A, Twadell S, Wooley M: Eosinophil apoptosis and the resolution of airway inflammation in asthma. Am J Respir Crit Care Med 1996; 154: 237-43.
Louis R, Lau L, Bron A, Roldaan A, Radermecker M, Djukanovic R: The relationship between airways inflammation and asthma severity. Am J Respir Crit Care Med 2000; 16: 9-16.
Bureau F, Seumois G, Jaspar F, Vanderplasschen A, Detry B, Pastoret PP, Louis R, Lekeux P: CD40 engagement enhances eosinophil survival through induction of cellular inhibitor of apoptosis protein 2 expression: possible involvment in allergic inflammation. J Allergy Clin Immunol 2002; 110: 443-9.
Brusasco V, Crimi E, Pellegrino R: Airway hyperresponsiveness in asthma: not just a matter of airway inflammation. Thorax 1998; 53: 992-8.
Leckie M, ten Brincke A, Khan J, Diamant Z, O'Connor B, Walls CM, Mathur AK, Cowley H, Chung KF, Djukanovic R, Hansel T, Holgate S, Sterck P, Barnes P: Effects of interleukin-5 blocking monoclonal antibody on eosinophils, airway hyperesponsiveness and the late asthmatic response. Lancet 2000; 356: 2144-8.
Louis E, Louis R, Shute J, Lau L, Franchimont D, Lamproye A, Radermecker M, Djukanovic R, Belaiche J: Bronchial eosinophilic infiltration in Crohn's disease in the absence of pulmonary disease. Clin Exp Allergy 1999; 29: 660-6.
Hunter C, Brightling C, Woltmann G, Wardlaw A, Pavord I: A comparison of the validity of different diagnotic tests in adults with asthma. Chest 2002; 121: 1051-7.
Pizzichini E, Pizzichini M, Efthimiadis A, Dolovich J, Hargreave F: Mesuring airway inflammation in asthma: eosinophils and eosinophilic cationic protein in induced sputum compared with peripheral blood. J Allergy Clin Immunol 1997; 99: 539-44.
Pavord I, Brightling C, Woltman G, Wardlaw A: Non eosinophilic corticosteroid unresponsive asthma. Lancet 1999; 353: 2213-4.
Szefler S, Martin R, Sharp King T, Boushey H, Cherniack R, Chinchilli V, Craig T, Dolovich M, Drazen J, Fagan J, Fahy J, Fish J, Ford J, Israel E, Kiley J, Kraft M, Lazarus S, Lemanske R, Mauger E, Peters S, Sorkness C: Significant variability in response to inhaled corticoids for persistent asthma. J Allergy Clin Immunol 2002; 109: 410-8.
Giannini D, Di Franco A, Cianchetti S, Bacci E, Dente F, Vaggagini B, Paggiaro P: Analysis of induced sputum before and after withdrawal of treatment with inhaled corticoids in asthmatic patients. Clin Exp Allergy 2000; 30: 1177-84.
Jatakanon A, Lim S, Barnes P: Changes in sputum eosinophils predict loss of asthma control. Am J Respir Crit Care Med 2000; 161: 64-72.
Leuppi J, Salome C, Jenkins C, Anderson S, Xuan W, Matks G, Koskella H, Brannan J, Freed R, Andersson M, Chan HK, Woolcock A: Predictive markers of asthma exacerbation during stepwise dose reduction of inhaled corticoids. Am J Respir Crit Care Med 2001; 163: 406-12.
Kharitonov S, Barnes P: Exhaled markers of pulmonary disease. Am J Respir Crit Care Med 2001; 163: 1693-722.
Chanez P, Godard P: L'analyse de l'expectoration induite dans l'asthme. Rev Mal Respir 2002; 19; 689-92.
Boniface S, Donati Y, Romanet-Manent S, Lorec AM, Dupuy P, Mamessier E, Badier M, El Biaze M, Koscher V, Vervloet D, Magnan A: L'analyse de l'expectoration induite dans l'asthme permet une nouvelle approche de l'inflammation. Rev Mal Respir 2002; 19; 747-59.