Changes in sputum composition between two inductions performed on consecutive days

Background - Sputum induction is a noninvasive method for obtaining cellular and biochemical material from the airways and appears to be particularly suited for repeated testing. However, it has not been clarified whether repeated inductions lead to a change in sputum composition. The aim of this study was to compare induced sputum results between two inductions performed 24 hours apart. Methods - Ten subjects with mild asthma and 19 healthy subjects were included. Sputum was obtained during three consecutive 10 minute periods of hypertonic saline inhalation. Samples were analysed separately for the three inhalation periods. Corresponding pooled values were computed, taking into account total cell numbers of each inhalation period. Results - In the three consecutive inhalation periods mean (SE) percentages of neutrophils increased from 29.2 (4.2)%, 22.0 (4.6)% and 14.5 (2.9)% on day 1 to 43.1 (5.3)%, 34.8 (5.5)% and 25.7 (5.3)% on day 2 in healthy subjects and from 21.3 (4.3)%, 24.1 (5.9)% and 15.9 (3.7)% to 35.9 (6.9)%, 30.7 (7.1)% and 31.8 (6.5)% in asthmatic subjects. This parallel shift corresponded to a mean (95% CI) increase in the pooled percentages of neutrophils of 17.4 (11.6 to 23.3)% in healthy and 14.6 (1.2 to 28.0)% in asthmatic subjects. In contrast to neutrophils, the percentage of macrophages decreased from day 1 to day 2, while eosinophil and lymphocyte percentages did not change significantly. Conclusion - These results suggest that the induction procedure itself causes a change in the composition of sputum detectable after 24 hours. This effect has to be taken into account when repeated sputum induction is performed.