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Effect of Sputum Induction on Spirometric Measurements and Arterial Oxygen Saturation in Asthmatic patients, Smokers, and Healthy Subjects^*

^* From the Department of Respiratory Disease, University of Parma, Parma, Italy.

Correspondence to: Antonio Castagnaro, MD, Istituto di Clinica delle Malattie dell'Apparato Respiratorio, Ospedale Rasori, Università di Parma, Viale G. Rasori 10, 43100 Parma, Italy; e-mail: respdis{at}ipruniv.cce.unipr.it

Background: Sputum production induced by inhalation of hypertonic saline solution has been proposed as a technique to collect secretions and inflammatory cells from the airways of subjects with bronchial asthma or with a history of smoking. The aim of this study was to determine the effect of a sputum induction procedure on spirometric results and arterial oxygen saturation (SaO₂) in asthmatic patients, smokers, and healthy subjects.

Methods: We recruited 14 subjects suffering from asthma (11 men and 3 women; age range, 18 to 49 years), 14 subjects with a history of smoking (5 men and 9 women; age range, 23 to 64 years), and 9 healthy volunteers (7 men and 2 women; age range, 28 to 54 years). To obtain a sample of induced sputum, all subjects inhaled a mist of 3% hypertonic saline solution nebulized for 5 min and repeated the cycle no more than four times. Asthmatic patients were pretreated with 200 µg salbutamol (inhaled). During sputum induction, the transcutaneous SaO₂ was continuously measured and baseline, fall, and the differences between baseline and fall SaO₂ were recorded. Additionally, we measured the duration of mild desaturation (change in SaO₂, < 4%) and of marked desaturation (change in SaO₂, > 5%) in each subject. Finally, baseline FEV₁ and changes in FEV₁ as a percentage of baseline values were recorded in all subjects.

Results: We found that baseline and fall SaO₂ values for the three groups were similar. However, in each group a significant mean change in SaO₂ was evident during sputum production (asthmatic patients, 6.0%; smokers, 5.3%; healthy subjects, 6.0%). Moreover, the mean durations of mild desaturation were 7 min, 21 s in asthma patients; 8 min, 24 s in smokers; and 7 min, 16 s in healthy subjects. Similarly, the durations of marked desaturation were 1 min, 25 s in asthmatic patients, 1 min, 19 s in smokers, and 1 min, 21 s in healthy subjects. The mean (± SD) fall in FEV₁ was not statistically different among the three groups (asthmatic patients, 1.36 ± 5.6%; smokers, 7.58 ± 11.76%; and healthy subjects, 0.05 ± 9.6%). However, one smoker did experience excessive bronchoconstriction (fall in FEV₁, > 20%).

Conclusions: This study demonstrated a significant and comparable fall in SaO₂ during sputum induction by inhalation of hypertonic saline solution in asthmatic patients, smokers, and healthy subjects. The results suggest that subjects who are hypoxemic before sputum induction require SaO₂ monitoring during the procedure.

Key Words: asthma • induced sputum • oxygen saturation • spirometric measurements

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