Some factors influencing quality of spontaneous or induced sputum for inflammatory cell analysis.

AIM: To find some simple clinical factors which can predict the quality of the sputum samples obtained in a large group of asthmatic subjects. METHODS: We compared the presence of sputum productive cough in the days preceding the test, easiness in expectoration during the test, and sputum macroscopic aspect (presence of visible plugs) with the quality of slides obtained from sputum processing. We also monitored changes in the quality in patients who repeated sputum collection several times, comparing those whose first sample was adequate with those whose first sample was inadequate. We analysed 547 sputum samples obtained from 238 asthmatic patients. Sputum was processed using the whole sample method. RESULTS: Patients with productive cough in the days preceding the test and easy expectoration during the test produced a higher percentage of adequate samples than those without productive cough (86% vs 76 %, p=0.01) and with difficulty in expectoration (85% vs 63%, p=0.0001). "Good" macroscopic samples were associated with better quality of slides (91% vs 38%, p=0.0001). Patients with inadequate first sample (n=40) had a higher percentage of inadequate samples (55%) in the subsequent tests than patients (n=115) with adequate first sample (8%). CONCLUSIONS: Patients with increased airway secretions in the days preceding the test, easy expectoration and "good" macroscopic aspect of the sputum are more likely to produce sputum sample adequate for inflammatory cell analysis. If the first sputum sample is adequate, subsequent samples are very likely to be adequate as well. If the first sputum sample is inadequate, the quality of subsequent samples cannot be predicted, since there are similar probabilities of having adequate or inadequate samples.

[Asthma in hairdressers: a report of 5 cases]. / Asma dei parrucchieri: descrizione di 5 casi.

The paper reports 5 cases of bronchial asthma in hairdressers exposed to bleaching dusts containing potassium and ammonium persulphate. All subjects complained of asthmatic symptoms at diagnosis, and underwent measurement of non-specific bronchial hyperresponsiveness to methacholine, skin prick tests for common allergens, PEF monitoring during 2 weeks at work, specific bronchial challenge (SBC) test with bleaching dust, and assessment of airway inflammation by induced sputum technique. All subjects were reassessed during a follow-up of 1 to 5 years. All subjects were negative for skin prick tests, but 3 showed an abnormal PEF variability at work (Maximal Amplitude > 10%, in at least half of the monitoring period). All subjects showed a positive airway response to SBC with bleaching dust, and 4 subjects did not react to the control tests with lactose dust. One subject only showed a high percentage of eosinophils (> 3%) in the induced sputum, while all were hyperreactive to methacholine (PD20FEV1 < 0.3 mg). During the follow-up, 2 subjects stopped working and 4 were treated by inhaled corticosteroids and bronchodilators. All subjects reported a significant improvement in asthmatic symptoms, related partly to the reduction of occupational exposure in the workplace and to the efficacy of anti-inflammatory treatment. In conclusion, similar findings were observed in these 5 cases of hairdresser asthma: absence of atopy, positive response to SBC, mild changes in PEF and variable percentages of eosinophils in induced sputum. Pharmacological treatment, associated with reduction of occupational exposure, could improve asthmatic symptoms, despite continuing the job.

[Specific bronchial provocation tests with flour in the diagnosis of occupational bronchial asthma]. / Il test di provocazione bronchiale specifico con polvere di farina nella diagnosi di asma bronchiale professionale.

The gold standard in the diagnosis of occupational asthma is the specific bronchial provocation test (sBPT), but other diagnostic criteria have been proven to have a similar sensitivity, mainly in asthma due to high molecular weight compounds. In order to assess wether some clinical findings can predict the positive response to sBPT, we studied 37 subjects (14 millers and 23 bakers) with suspected occupational asthma who underwent sBPT with wheat flour dust (dust exposure in a small cabin: geometric mean 12.1 mg/m3 for up to 30 min). A positive response to sBPT (FEV1 > 20%) was elicited in 20 subjects (11 early, 4 late, and 5 dual responses). There was no significant difference between subjects with positive or negative sBPT as regards mean age, smoking, length of employment, duration of symptoms, atopy (skin positivity to one or more common allergens) and PD20FEV1 methacholine. The percentage of subjects with work-related symptoms was significantly higher in subjects with positive sBPT with respect to subjects with negative sBPT (81% versus 41.2%, p < 0.01 by chi 2 test); furthermore, FEV1 was significantly lower in subjects with positive sBPT. The percentage of positive skin response to wheat flour extract (mean wheal diameter > or = 3 mm) was mildly but not significantly higher in subjects with positive sBPT (68.4% versus 41.2%). None of the following clinical factors (age < 35 years, asthma symptoms pre-existing occupational exposure, non smokers, atopy and bronchial hyperresponsiveness to methacholine), alone or in combination, were associated with higher prevalence of positive sBPT. We conclude that the response to sBPT in subjects with suspected occupational asthma due to flour dust can not be adequately predicted by other clinical, allergologic and functional data. Therefore, sBPT with flour dust should always be performed in subjects with suspected occupational asthma.