Escola Paulista de Medicina
Graduate Program in Pulmonology

Nasal lavage, blood or sputum: Which is best for phenotyping asthma?

capa respirology 2017 v22 4Autores: Camyla F. de Farias, Maria M.F. Amorim, Michel Dracoulakis, Lilian B. Caetano, Ilka L. Santoro, Ana L.G. Fernandes


Respirology Volume 22, Issue 4 May 2017 Pages 671–677 • doi:10.1111/resp.12958


Abstract: 

Background and objective

Determination of asthma phenotypes, particularly inflammatory phenotypes, helps guide treatment and management of this heterogeneous disease. Induced sputum cytology has been the gold standard for determination of inflammatory phenotypes, but sputum induction is fairly invasive and technically challenging. Blood and nasal lavage cytology have been suggested as substitutes, but have not been fully verified. The aim of this study is to determine the accuracy of blood and nasal lavage cytometry as indicators of inflammatory phenotypes in asthma.

Methods

Clinical evaluation, Asthma Control Questionnaire (ACQ) and spirometry were performed for 121 adult asthma patients, and blood, nasal lavage and induced sputum samples were taken. Eosinophils and neutrophils were counted in three samples from each subject. Inflammatory phenotypes (eosinophilic, neutrophilic, mixed and paucicellular) and cells counts were analysed using Venn diagram and receiver operating characteristic (ROC) curve, respectively.

Results

ACQ score, spirometry and bronchodilator response did not differ among subjects with different inflammatory phenotypes. Inflammatory phenotypes defined by nasal lavage cytometry were in better concordance than those defined by blood cell counts with phenotypes determined by sputum cytology, and were significantly correlated with sputum phenotypes. For eosinophilia, nasal lavage cytology showed better accuracy than blood cytology (area under the curve (AUC): 0.89 vs 0.65). For all phenotypes, sensitivity and positive and negative predictive power were higher for nasal lavage cytometry than for blood. Blood cell counts gave a high level of false positives for all inflammatory phenotypes.

Conclusion

We recommend nasal lavage cytology over blood cell count as a substitute for sputum cytology to identify inflammatory phenotypes in asthma.

Artigos Relacionados - Artigos Científicos

01 Jun 2017 17:35

Autor: Pinheiro L, Santoro IL, Faresin SM.

Canadian Respiratory Journal Volume 2016 (2016), [ ... ]

Artigos Cientificos
01 Jun 2017 17:05

Autores: Camyla F. de Farias, Maria M.F. Amorim, Michel Dracoulakis, Lilian B. Caetano, Ilka L. Santoro, [ ... ]

Artigos Cientificos
01 Jun 2017 17:35

Autor: Gérson F Souza, Graciane L Moreira, Andréa Tufanin, Mariana R Gazzotti, Antonio [ ... ]

Artigos Cientificos

© 2013 - 2017 Universidade Federal de São Paulo - Unifesp

Rua Botucatu, 740 – 2º andar - Vila Clementino  •   São Paulo- SP   •   CEP 04023-062
+55 11 5576 4848 Ramal 3030   •   ppg.pneumologia@unifesp.br