• Title/Summary/Keyword: Sputum Cell Count

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Increased B cell-activating factor (BAFF) level in the sputum of children with asthma

  • Jee, Hye-Mi;Choi, Bong-Seok;Kim, Kyung-Won;Sohn, Myung-Hyun;Han, Man-Yong;Kim, Kyu-Earn
    • Clinical and Experimental Pediatrics
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    • v.53 no.8
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    • pp.795-800
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    • 2010
  • Purpose: B cell-activating factor (BAFF) is a tumor-necrosis factor (TNF) superfamily member best known for its role in the survival and maturation of B cells. BAFF activity is observed in naive cells as well as in effector/memory T cells. We aimed to explore whether BAFF in sputum is expressed at elevated levels in asthmatic airways and associated with eosinophilic inflammation, pulmonary function, and bronchial hyperresponsiveness in children. Methods: One hundred and fifty-four asthmatic children and 98 healthy children were enrolled in the study. Sputum supernatants were collected and sputum BAFF and eosinophil cationic protein (ECP) levels were measured. We performed pulmonary function tests and methacholine challenge tests, while measuring total eosinophil count, total serum IgE, and serum ECP in all subjects. Results: Asthmatic children had significantly higher levels of BAFF in induced sputum [26.50 (10.50-100.27) pg/mL] compared to healthy children [18.32 (7.68-44.63) pg/mL; $P$=0.011]. Sputum BAFF positively correlated with sputum eosinophils (${\gamma}$=0.406, $P$<0.001) and sputum ECP (${\gamma}$=0.789, $P$<0.001). Significant negative correlations were found between sputum BAFF and FEV1 (${\gamma}$=-0.291, $P$<0.001) or post-bronchodilator FEV1 (${\gamma}$=-0.334, $P$<0.001), whereas nonsignificant correlations were found between sputum BAFF and bronchial hyperresponsiveness, serum eosinophil count, and serum ECP. Conclusion: These findings suggest that BAFF may play a role in childhood asthma, and BAFF levels in sputum could be a supportive marker that represents airway inflammation, especially eosinophilic inflammation.

Sputum Inflammometry to Manage Chronic Obstructive Pulmonary Disease Exacerbations: Beyond Guidelines

  • Venegas, Carmen;Zhao, Nan;Ho, Terence;Nair, Parameswaran
    • Tuberculosis and Respiratory Diseases
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    • v.83 no.3
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    • pp.175-184
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    • 2020
  • Quantitative sputum cytometry facilitates in assessing the nature of bronchitis associated with exacerbations of chronic obstructive pulmonary disease (COPD). This is not assessed in most clinical trials that evaluate the effectiveness of strategies to prevent or to treat exacerbations. While up to a quarter of exacerbations may be associated with raised eosinophil numbers, the vast majority of exacerbations are associated with neutrophilic bronchitis that may indicate airway infections. While eosinophilia may be a predictor of response to corticosteroids (oral and inhaled), the limited efficacy of anti-interleukin 5 therapies would suggest that eosinophils may not directly contribute to those exacerbations. However, they may contribute to airspace enlargement in patients with COPD through various mechanisms involving the interleukin 13 and matrix metalloprotease pathways. The absence of eosinophils may facilitate in limiting the unnecessary use of corticosteroids. The presence of neutrophiia could prompt an investigation for the specific pathogens in the airway. Additionally, sputum measurements may also provide insight into the mechanisms of susceptibility to airway infections. Iron within sputum macrophages, identified by hemosiderin staining (and by more direct quantification) may impair macrophage functions while the low levels of immunoglobulins in sputum may also contribute to airway infections. The assessment of sputum at the time of exacerbations thus would facilitate in customizing treatment and treat current exacerbations and reduce future risk of exacerbations.

KAAACI Standardization Committee report on the procedure and application of induced sputum examination (유도객담검사의 시행과 해석: 전문가 의견서)

  • Kim, Min-Hye;Kim, Mi-Yeong;Lim, Kyung-Hwan;Yang, Min-Suk;Song, Woo-Jung;Lee, Jeongmin;Suh, Dong In;Shin, Yoo Seob;Kwon, Jae-Woo;Kim, Sae-Hoon;Kim, Sang-Heon;Lee, Byung-Jae;Cho, Sang-Heon;Jung, Jae-Woo;Academy of Asthma, Allergy and Clinical Immunology Standardization Committee
    • Allergy, Asthma & Respiratory Disease
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    • v.5 no.6
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    • pp.307-311
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    • 2017
  • Induced sputum and sputum cell count analysis is a test for the diagnosis of various respiratory diseases. In particular, it has long been used as an important biomarker in the diagnosis or characterization of asthma or eosinophilic bronchitis. Despite a relatively long history of this test, there has been no consensus report for conducting and interpreting the analyses in Korea. Based on this awareness and necessity, the Korean Academy of Asthma, Allergy and Clinical Immunology launched the Standardization Committee to review the international guidelines and the literature and to develop a consensus report on the diagnostic procedure and interpretation of the sputum induction test.

Cellular Analysis and Measurement of Mucin in Sputum of Chronic Airway Disease (만성기도질환의 객담세포분석과 mucin의 측정)

  • Kim, Ki-Up;Kim, Yang-Ki;Shin, Chan-Young;Kim, Do-Jin;Uh, Soo-Taek;Kim, Yong-Hoon;Ko, Kwang-Ho;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.1
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    • pp.82-92
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    • 2000
  • Background : In chronic airway disease, mucus secretion is increased, but extraction of mucin, which is the main component of mucus secretion, is a very complicated and limited in clinical use. Recently, monoclonal antibody for mucin was developed for possible clinical use. In this study, cellular analysis and quantification of respiratory mucin in sputum of patients with chronic airway diseases were performed. Method : Sputum was collected from patients with asthma(n=33), bronchiectasis(n=8) or chronic bronchitis (n=13) by spontaneous expectoration or by hypertonic saline induction. Collected sputums was treated by 0.1% dithiotreitol to dissociate the disulfide bond of the mucus and filtered through a nylon gauze. Total cell count, viability and differential count were measured. For detection of mucin, collected samples were treated with sodium dodecyl sulfate polyacrylamide gel electrophoresis and then with monoclonal antibody(HMO2), as the primary antibody, and PAS stain. The amount of mucin was measured with ELISA by HMO2. Correlation with clinical information, cellular analysis, and amount of measured mucin were analyzed. Results : Total cell counts of sputum were significantly increased in patients with bronchiectasis but viability remained the same. Eosinophils were significantly increased in patients with asthma, neutrophils in bronchiectasis chronic bronchitis, respectively (p<0.05). The results of Western blotting and PAS staining confirmed the presence of glycoproteins and matched? with mucin. The amounts of mucin measured by ELISA were not significantly different among the disease groups. Significant correlation was identified between the amount of mucin and viability(r=-0.482, p<0.05). Conclusion : Inflammatory cells in the sputum of those with chronic airway disease were different for each disease type. Measurement of mucin by ELISA via monoclonal antibodies may be a simple method for the evaluation of chronic airway disease.

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Relationship Between Airway Inflammation Assessed by Induced Sputum and Airway Hyperresponsiveness in Asthmatic Patient (기관지천식 환자에서 유도객담으로 평가한 기도염증과 기관지 과민성과의 관계)

  • Chung, Lee-Young;Kim, Hyun-Jin;Jeong, Gyeong-Won;Kang, Mi-Jeong;Kim, Hwi-Jong;Chung, Hyo-Young;Lee, Jong-Deog;Hwang, Young-Sil
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.4
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    • pp.517-524
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    • 1999
  • Background : Airway inflammation and hyperresponsiveness are recognized as major characteristics of bronchial asthma. Airway inflammation has usually been assessed by invasive methods, e.g. BAL or bronchial biopsy, but recent studies proposed induced sputum as another reliable and non-invasive tool to investigate airway inflammation in asthmatic patients. Thus, the relationship between airway inflammation assessed by induced sputum and airway hyperresponsiveness was investigated in asthmatic patient. Method : Airway responsiveness was determined by the concentration that caused a 20% decrease in $FEV_1$($PC_{20}$) after inhaling incremental concentrations of methacholine. The numbers of inflammatory cells and the concentration of eosinophilic cationic protein(ECP) were assessed in induced sputum obtained by inhalation of hypertonic saline(3%). Result: We analyzed sputum induced in 15 stable asthmatic patients. The differential cell count(%) of macrophages, neutrophils, eosinophils and lymphocytes in induced sputum were $39.1{\pm}27.0%$, $29.6{\pm}21.0%$, $28.8{\pm}18.8%$, $1.3{\pm}3.1%$ respectively. The mean value of baseline FEV1(predicted) and ECP were $76.3{\pm}30.3%$ and $1,101{\pm}833{\mu}g/L$ respectively. The geometric mean value of $PC_{20}$ was 0.56 mg/mL. The relationships between the sputum eosinophil and ECP in induced sputum, and between sputum eosinophil and degree of airway responsiveness($PC_{20}$) were found to be significantly correlated (r=0.81, p<0.05 and r=-0.78, p<0.05, respectively). Sputum neutrophils and $PC_{20}$ were not correlated to each other (r=0.11, p=0.69) and a significant negative correlation was found between ECP and baseline $FEV_1$(predicted)(r=-0.62, p<0.05). Conclusion : The results of this study suggest that an induced sputum via a inhalation of hypertonic saline is useful to determine a patient's status of airway inflammation, and airway inflammation is one of the major causal factors in the development of bronchial hyperresponsiveness in asthmatic patients.

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The Bronchoalveolar Lavage Fluid Cell Analysis with Normal Lung and Unaffected Side Lung of Patients with Minor Symptoms or Radiologic Abnormalities (경미한 호흡기질환 환자에서 정상 및 건측 폐에서의 기관지폐포 세척액내 세포 분포에 관한 연구)

  • Kim, Byung-Il;Cho, Chul-Ho;Kang, Shin-Wook;Cheon, Seon-Hee;Jang, Sang-Ho;Lee, Jang-Hoon;Chang, Joon;Kim, Sung-Kyu;Lee, Won-Young
    • Tuberculosis and Respiratory Diseases
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    • v.38 no.2
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    • pp.155-163
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    • 1991
  • Bronchoalveolar lavage had been done as the treatment of some diseases such as alveolar proteinsois, bronchiectasis, and severe asthma to remove excessive secretion or mucus. But in the recent decade it has been done as a diagnostic method and a tool to understand and evaluate the pathophysiology of diffuse interstitial lung diseases such as sarcoidosis, pneumoconiosis and hypersensitivity pneumonitis. To analyse the bronchoalveolar fluid, it might be useful to have a standard reference (especially cell counts and differetial count of the cells from bronchoalveolar lavage fluid) of normal person. But it is difficult to study the normal volunteers. We investgated the bronchoalveolar lavage fluid of 48 patients (28 nonsmokers, 20 smokers) who visited Severance Hospital because of minor pulmonary symptoms such as cough and sputum. They did neither complain of dyspnea nor cyanosis, and had normal or unilateral minor lesion on physical examination and chest X-ray. We analysed the recovery rate, viability, total cell count and differential count of the cells in fluid obtained by bronchoalveolar lavage. The following results were obtained: 1) Age ranged from 17 to 72 years-old with the mean age of 36.7; there was no difference of age between the nonsmoker and the smoker gorup. Male to female ratio was 2.43:1 for total group, 1.15:1 for nonsmokers, and 19:1 for smokers. 2) The diagnoses of the patients were undetermined in 41.9%, healed pulmonary tuberculosis in 37.5%, laryngitis or pharyngitis in 10.4% and others in 10.4%. 3) Total cell number of the recovered fluid by bronchoalveolar lavage was significantly higher in male[$9.6{\pm}6.2({\times}10^6)$] than in female[$5.1{\pm}3.0({\times}10^6)$](p<0.05), and there was no significant difference in the total cell number between the smokers and nonsmokers [$9.3{\pm}5.8({\times}10^6)$ vs $7.5{\pm}5.8({\times}10^6)$]. 4) The differential count of the cells from bronchoalveolar lavage fluid had no difference between the nonsmokers and the smokers. 5) There was no correlation between the total cell count and smoking or age. 6) In the smoker group, there was no correlation between the amount of smoking and the total cell count of the bronchoalveolar fluid. In conclusion, it should be careful to regard the patients with symptoms or minor radiologic abnormalities as a control group in bronchoalveolar lavage study and further study of cell analysis in bronchoalveolar lavage will be needed between smoker and nonsmoker in the male and female healthy people.

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Incidence and Risk Factors of Pneumonia in Hospitalized Patients with Seasonal Influenza A or B

  • Chu, Seongjun;Park, Sang Joon;Koo, So My;Kim, Yang Ki;Kim, Ki Up;Uh, Soo-Taek;Kim, Tae Hyung;Park, Suyeon
    • Tuberculosis and Respiratory Diseases
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    • v.80 no.4
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    • pp.392-400
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    • 2017
  • Background: Most patients with influenza recover spontaneously or following treatment with an anti-viral agent, but some patients experience pneumonia requiring hospitalization. We conducted a retrospective review to determine the incidence and risk factors of pneumonia in hospitalized patients with influenza A or B. Methods: A total of 213 patients aged 18 years or older and hospitalized with influenza between January 2012 and January 2015 were included in this study. A reverse-transcriptase polymerase chain reaction assay was used to detect the influenza A or B virus in the patients' sputum samples. We collected demographic and laboratory data, combined coexisting diseases, and radiologic findings. Results: The incidence of pneumonia was higher in patients in the influenza A group compared to those in the influenza B group (68.6% vs. 56.9%), but this difference was not statistically significant. The presence of underlying respiratory disease was significantly associated with pneumonia in the influenza A group (adjusted odds ratio [OR], 3.975; 95% confidence interval [CI], 1.312-12.043; p=0.015). In the influenza B group, the white blood cell count (adjusted OR, 1.413; 95% CI, 1.053-1.896; p=0.021), platelet count (adjusted OR, 0.988; 95% CI, 0.978-0.999; p=0.027), and existence of an underlying medical disease (adjusted OR, 15.858; 95% CI, 1.757-143.088; p=0.014) were all significantly associated with pneumonia in multivariate analyses. Conclusion: The incidence of pneumonia was 65.7% in hospitalized patients with influenza A or B. The risk factors of pneumonia differed in hospitalized patients with influenza A or B.

Experimental Study on Anti-inflammatory, Antitussive, and Expectoration Effects of Friltillariae Thunbergii Bulbus (절패모(浙貝母)의 항염 및 진해거담 효과에 대한 실험연구)

  • Kim, Jin Hoo;Yang, Won Kyung;Lee, Su Won;Lyu, Yee Ran;Kim, Seung Hyung;Park, Yang Chun
    • The Journal of Internal Korean Medicine
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    • v.41 no.3
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    • pp.339-349
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    • 2020
  • Objective: This study aimed to evaluate anti-inflammatory and antitussive expectoration effects of Friltillariae Thunbergii Bulbus (FTB) in a mouse model. Materials and Methods: To evaluate the anti-inflammatory effects of the FTB, we conducted in vitro experiments using RAW264.7 cells. An MTT assay and enzyme-linked immunosorbent assay (ELISA) were carried out to examine the anti-inflammatory effects of FTB. The expectorant effect on phenol red secretion, the antitussive effect on cough induced by ammonia solution, and leukocyte increased inhibition effects in acute airway inflammation in the animal model were confirmed. Results: FTB did not show cytotoxicity in the experimental group at 10, 30, 50, 100, 300, or 500 ㎍/ml and significantly inhibited the increase of NO, TNF-α and IL-6 in the experimental groups at 30, 50, 100, 300, and 500 ㎍/ml concentrations. In sputum, cough, and acute airway inflammation animal models, FTB significantly increased phenol red secretion in the 400 mg/kg administration group. FTB significantly reduced the number of coughs and significantly increased cough delay time in both 200 and 400 mg/kg dose groups. FTB decreased the white blood cell count in BALF (bronchoalveolar lavage fluid) in the 400 mg/kg administration group. Conclusion: Our study revealed that FTB elicits antitussive and expectorant effects by inhibiting inflammatory cytokines, increasing sputum secretion, suppressing cough, and reducing inflammatory cells. We concluded that FTB is a highly promising agent for respiratory tract infection with therapeutic opportunities.

Analysis of the Impact on Community Health after Accidental Leak of Hydrofluoric Acid (일개 응급의료센터에서 분석한 불화수소산 대량 누출이 지역사회 건강에 미친 영향)

  • Kim, Young Gab;Lee, Ju Taek;Park, Sang Hyun;Lee, Chan Hee;Choe, Michael Sung Pil;Je, Dong Wook;Lee, Chang Jae;Ko, Taei;Jo, Hye Jung
    • Journal of The Korean Society of Clinical Toxicology
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    • v.11 no.2
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    • pp.106-113
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    • 2013
  • Purpose: The purpose of this study is to verify the influence of a massive hydrofluoric acid spill on community health through patients who claimed to have been exposed. Methods: We analyzed 2459 patients who visited our emergency department with the claim of exposure to hydrofluoric acid, and retrospective analyses were performed. We analyzed changes in numbers of visitors per day from the day of the accidental hydrofluoric acid spill, symptoms presented by the 1924 patients, and general characteristics. Comparisons of symptoms and hematologic characteristics were made between the initially set evacuation zone(1.3 km radius parameters from the spill) and the outer zone. Results: A total of 2,459 patients who claimed exposure visited our ED from 27 September 2012 to 23 October 2012, and there was a significant increase in the number of visiting patients from day 8 of the hydrofluoric acid spill. The most common complaints were a sore throat, 729(37.9%) and no specific symptom with health concern, 547 (28.4%). Statistically significant findings were pulmonary symptoms (p=0.001), nasal symptoms (p=0.001), diarrhea (p=0.023), and skin symptoms (p=0.007). In hematologic study, a statistically significant difference was observed in white blood cell count (p=0.018), creatine phosphokinase (p<0.001), erythrocyte sediment rate (p=0.013), and phosphorus (p<0.001). Conclusion: A significant increase in the number of patients was observed one week after the accidental spill of hydrofluoric acid. The most frequent symptoms were sore throat, headache, cough, and sputum. Statistically significant increase in creatine phosphokinase level and decrease in phosphorus level were noted in patients within the evacuation zone.

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Studies on Ancylostomiasis I. An Experimental Study on Hookworm Infection and Anemia (구충증(鉤蟲症)에 관(關)한 연구(硏究) 제1편(第1篇) 구충(鉤蟲)의 감염(感染) 및 구충성빈혈(鉤蟲性貧血)에 관(關)한 고찰(考奈))

  • Lee, Mun-Ho;Kim, Dong-Jip;Lee, Jang-Kyu;Seo, Byong-Sul;Lee, Soon-Hyung
    • The Korean Journal of Nuclear Medicine
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    • v.1 no.1
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    • pp.55-66
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    • 1967
  • In view of its prevalence in the Far East area, a more detailed knowledge on the hookworm infection is one of the very important medical problems. The present study was aimed to; determine the infectivity of the artificially hatched ancylostoma duodenale larvae in man after its oral administration, evaluate the clinical symptomatology of such infection, determine the date of first appearance of the ova in the stool, calculate the blood loss per worm per day, assess the relation-ships between the ova count, infectivity(worm load), blood loss and severity of anemia. An erythrokinetic study was also done to analyse the characteristics of hookworm anemia by means of $^{59}Fe\;and\;^{51}Cr$. Materials and Methods Ten healthy male volunteers(doctors, medical students and laboratory technicians) with the ages ranging from 21 to 40 years were selected as the experimental materials. They had no history of hookworm infection for preceding several years, and care was taken not to be exposed to reinfection. A baseline study including a through physical examinations and laboratory investigations such as complete blood counts, stool examination and estimation of the serum iron levels was done, and a vermifuge, bephenium hydroxynaphoate, was given 10 days prior to the main experiment. The ancylostoma duodenale filariform larvae were obtained in the following manner; The pure ancylostoma duodenale ova were obtained from the hookworm anemia patients and a modified filter paper method was adopted to harvest larger number of infective larvae, which were washed several times with saline. The actively moving mature larvae were put into the gelatine capsules, 150 in each, and were given to the volunteers in the fasting state with 300ml. of water. The volunteers were previously treated with intramuscular injection of 15mg. of chlorpromazine in order to prevent the eventual nausea and vomiting after the larvae intake. The clinical symptoms and signs mainly of the respiratory and gastrointestinal tracts, appearance of the ova and occult blood in the stool etc. were checked every day for the first 20 days and then twice weekly until the end of the experiment, which usually lasted for about 3 months. Roentgenological survey of the lungs was also done. The hematological changes such as the red blood cell, white blood cell and eosinophil cell counts, hemoglobin content and serum iron levels were studied. The appearance of the ova in the stool was examined by the formalin ether method and the ova were counted in triplicate on two successive days using the Stoll's dilution method. The ferrokinetic data were calculated by the modified Huff's method and the apparent half survival time of the red blood cells by the modified Gray's method. The isotopes were simultaneously tagged and injected intravenously, and then the stool and blood samples were collected as was described by Roche et al., namely, three separate 4-day stool samples with the blood sample drawing before each 4-day stool collection. The radio-activities of the stools ashfied and the blood were separately measured by the pulse-height analyser. The daily blood loss was calculated with the following formula; daily blood loss in $ml.=\frac{cpm/g\;stool{\times}weight\;in\;g\;of\;4-day\;stool}{cpm/ml\;blood{\times}4}$ The average of these three 4-day periods was given as the daily blood loss in each patient. The blood loss per day per worm was calculated by simply dividing the daily blood loss by the number of the hookworm recovered after the vermifuge given twice a week at the termination of the experiment. The iron loss in mg. through the gastrointestinal tract was estimated with the daily iron loss in $mg=\frac{g\;Hgb/100ml{\times}ml\;daily\;blood\;loss{\times}3.40}{100}$ 3.40=mg of iron per g Hgb following formula; Results 1. The respiratory symptoms such as cough and sputum were noted in almost all cases within a week after the infection, which lasted about 2 weeks. The roentgenological findings of the chest were essentially normal. A moderate degree of febril reaction appeared within 2 weeks with a duration of 3 or 4 days. 2. The gastrointestinal symptoms such as nausea, epigastric fullness, abdominal pain and loose bowel appeared in all cases immediately after the larvae intake. 3. The reduction of the red blood cell count was not remarkable, however, the hemoglobin content and especially the serum iron level showed the steady decreases until the end of the experiment. 4. The white blood cells and eosinophil cells, on the contrary, showed increases in parallel and reached peaks in 20 to 30 days after the infection. A small secondary rise was noted in 2 months. 5. The ova first appeared in the stool in 40. 1 days after the infection, ranging from 29 to 51 days, during which the occult blood reaction of the stool became also positive in almost cases. 6. The number of ova recovered per day was 164, 320 on the average, ranging from 89,500 to 253,800. The number of the worm evacuated by vermifuge was in rough correlation with the number of ova recovered. 7. The infectivity of ancylostoma duodenale was 14% on the average, ranging from 7.3 to 20.0%, which is relatively lower than those reported by other workers. 8. The mean fecal blood loss was 5.78ml. per day, with a range of from 2.6 to 11.7ml., and the mean blood loss per worm per day was 0.30ml., with a range of from 0.13 to 0.73ml., which is in rough coincidence with those reported by other authors. There appeared to exist, however, no correlation between the blood loss and the number of ova recovered. 9. The mean fecal iron loss was 2.02mg. per day, with a range of from 1.20 to 3.89mg., which is less than those appeared in the literature. 10. The mean plasma iron disappearance rate was 0.80hr., with a range of from 0.62 to 0.95hr., namely, a slight accerelation. 11. The hookworm anemia appeared to be iron deficiency in origin caused by continuous intestinal blood loss.

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