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Published ahead of print on July 21, 2004, doi:10.1164/rccm.200403-380OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 8, October 2004, 845-850

A more recent version of this article appeared on October 15, 2004
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Submitted on March 24, 2004
Accepted on July 17, 2004

An Effective Strategy for Diagnosing Occupational Asthma: Use of Induced Sputum

Frederic Girard1, Simone Chaboillez1, Andre Cartier1, Johanne Cote2, Frederick E Hargreave3, Manon Labrecque1, Jean-Luc Malo1, Susan M Tarlo4, and Catherine Lemiere1*

1 Department of Respirology, Hopital du Sacre-Coeur, Montreal, Quebec, Canada, 2 Department of Respirology, Hopital Laval, Sainte-Foy, Quebec, Canada, 3 Department of Respirology, St-Joseph's Healthcare, Hamilton, Ontario, Canada, 4 Department of Respirology, Toronto Western Hospital, and Gage Occupational and Environmental Health Unit, Toronto, Ontario, Canada

* To whom correspondence should be addressed. E-mail: lemierec{at}crhsc.umontreal.ca.

Monitoring airway inflammation by means of induced sputum cell counts seems to improve the management of asthma. We sought to assess whether such monitoring at the end of periods at and away from work combined with the monitoring of peak expiratory flow (PEF) could improve the diagnosis of occupational asthma. We enrolled subjects suspected of having occupational asthma. Serial monitoring of PEF was performed during 2 weeks at and away from work. At the end of each period, induced sputum was collected. Specific inhalation challenge was subsequently performed. PEF graphs were interpreted visually by five independent observers. Forty-nine subjects, including 23 with positive specific inhalation challenge, completed the study. The addition of sputum cell counts to the monitoring of PEF increased the specificity of this test respectively by 18% (range 13.7-25.5) or 26.8% (24.8- 30.4) depending if an increase of sputum eosinophils greater than 1 or 2% when at work was considered as significant. The sensitivity increased by 8.2% (4.1 -13.4) or decreased by 12.3% (3.1-24.1) depending on the cut-off in sputum eosinophils chosen (greater than 1 or 2% respectively). The addition of sputum cell counts to PEF monitoring is useful to improve the diagnostic of occupational asthma.
Key words: occupational asthma, specific inhalation challenge, peak expiratory flow, induced sputum, eosinophils




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