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This Article Full Text (PDF) All Versions of this Article: chest.07-2259v1 133/1/176    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mussaffi, H. Articles by Blau, H. Search for Related Content PubMed PubMed Citation Articles by Mussaffi, H. Articles by Blau, H.

Induced sputum in the very young: a new key to infection and inflammation

¹The Pulmonary Unit and the Kathy and Lee Graub Cystic Fibrosis Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel ²The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ³National Laboratory Center for Interstitial Lung Diseases, Institute for Pulmonary and Allergic Diseases, Sourasky Medical Center, Tel Aviv, Israel

hblau{at}post.tau.ac.il

Abstract

Background: Chronic inflammation and infection in cystic fibrosis (CF) and other lung diseases begin early, making non-invasive diagnostic techniques vital. As induced sputum (IS) is useful in older patients, we investigated its adaptation to young non-expectorating children.

Methods: Following 4.5% saline inhalation, sputum was collected by naso- or oropharyngeal suction for culture and inflammatory markers, with paired preceding oropharyngeal cough swabs (OCS) in a subgroup. Forty-eight IS procedures (46 successful) from 20 CF children, median age 3y, were compared with 8 specimens from 8 non-CF pulmonary patients, median age 4.5y.

Results: The procedure was safe, SaO₂ remaining 96%. In CF, 14/46 (30%) cultured P. aeruginosa whereas 19/46 (41%) had no growth. In non-CF, 7/8 cultured bacteria, none P. aeruginosa. Comparing 29 paired IS and OCS: 11 versus 5 cultured P. aeruginosa (not significant) whereas 12 versus 21 had no growth (p=0.02). A correlation was found between independent inflammatory markers neutrophil elastase (NE) and both IL-8 (r=0.85, p< 0.001) and % neutrophils (r=0.35, p<0.05), confirming validity of IS in evaluating early airway disease. IL-8 also increased with age (r=0.41, p<0.05). Inflammation was similar in CF and non-CF subjects.

Conclusions: IS in the young is feasible, safe and clinically useful, and could serve as an outcome measure for new therapies.

Key Words: cystic fibrosis • induced sputum • infection • inflammation • non-expectorating