An Effective Strategy for Diagnosing Occupational Asthma
Use of Induced Sputum
Frédéric Girard,
Simone Chaboillez,
André Cartier,
Johanne Côté,
Frederick E. Hargreave,
Manon Labrecque,
Jean-Luc Malo,
Susan M. Tarlo and
Catherine Lemière
Hôpital du Sacré-Coeur de Montréal, Montreal; Hôpital Laval, Sainte Foy, Quebec; St-Joseph's Healthcare, Hamilton; and Gage Occupational and Environmental Health Unit, Toronto Western Hospital, Toronto, Ontario, Canada
Correspondence and requests for reprints should be addressed to Catherine Lemière, M.D., Department of Chest Medicine, Sacré-Coeur Hospital, 5400 West Gouin, Montreal, PQ, H4J 1C5 Canada. E-mail: lemierec{at}crhsc.umontreal.ca
Monitoring airway inflammation by means of induced sputum cellcounts seems to improve the management of asthma. We soughtto assess whether such monitoring at the end of periods at andaway from work combined with the monitoring of PEF could improvethe diagnosis of occupational asthma. We enrolled subjects suspectedof having occupational asthma. Serial monitoring of PEF wasperformed during 2 weeks at and away from work. At the end ofeach period, induced sputum was collected. Specific inhalationchallenge was subsequently performed. PEF graphs were interpretedvisually by five independent observers. Forty-nine subjects,including 23 with positive specific inhalation challenge, completedthe study. The addition of sputum cell counts to the monitoringof PEF increased the specificity of this test, respectively,by 18 (range [r] 13.7–25.5) or 26.8% (r 24.8–30.4)depending if an increase of sputum eosinophils greater than1 or 2% when at work was considered as significant. The sensitivityincreased by 8.2% (r 4.1–13.4) or decreased by 12.3% (r3.1–24.1) depending on the cutoff value in sputum eosinophilschosen (greater than 1 or 2%, respectively). The addition ofsputum cell counts to PEF monitoring is useful to improve thediagnosis of occupational asthma.
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