Am. J. Respir. Crit. Care Med., Volume 156, Number 1, July 1997, 299-303

Safety of One Method of Sputum Induction in Asthmatic Subjects

HOFER H. WONG and JOHN V. FAHY

The Departments of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, California

To assess the safety of sputum induction in asthmatic subjects, we conducted a retrospective review of data from 351 sputum inductions in 78 subjects from our institution. The sputum induction protocol consisted of baseline FEV₁, pretreatment with albuterol 180 µg, postbronchodilator spirometry 15 min later, the induction procedure itself (inhalation of 3% saline for 20 min), and postsputum induction spirometry. We found that sputum induction was usually well tolerated, although some subjects developed wheeze and dyspnea. Overall, 11 of the 78 subjects (14%) had a fall in FEV₁ of  20% from the postbronchodilator baseline ("excessive bronchoconstriction") during their first sputum induction (range: 20 to 69%); no subject developed refractory bronchoconstriction requiring hospitalization or emergency room treatment. Only one of the 54 subjects (1.9%) with a baseline prebronchodilator FEV₁ > 80% had excessive bronchoconstriction, whereas 10 of the 24 subjects (42%) whose baseline FEV₁ was 80% predicted did so. The change in FEV₁ during sputum induction was significantly correlated with the baseline prebronchodilator FEV₁ % predicted, the baseline postbronchodilator FEV₁ % predicted, the PC₂₀ for methacholine, and the percentage of eosinophils in induced sputum. We conclude that 180 µg albuterol does not prevent excessive bronchoconstriction in all asthmatic subjects undergoing sputum induction, especially in asthmatic subjects with a low baseline FEV₁. Pulmonary function should be monitored regularly during sputum induction in asthmatic subjects to monitor for excessive bronchoconstriction.

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