title: Assessing airway inflammation in clinical practice - experience with spontaneous sputum analysis.
abstract: BACKGROUND
  The assessment of airway inflammation for the diagnosis of asthma or COPD is still uncommon in pneumology-specialized general practices. In this respect, the measurement of exhaled nitric oxide (NO), as a fast and simple methodology, is increasingly used. The indirect assessment of airway inflammation, however, does have its limits and therefore there will always be a need for methods enabling a direct evaluation of airway inflammatory cell composition. Sampling of spontaneous sputum is a well-known, simple, economic and non-invasive method to derive a qualitative cytology of airway cells and here we aimed to assess today's value of spontaneous sputum cytology in clinical practice.
  
  
  METHODS
  Three pneumologists provided final diagnoses in 481 patients having sputum cytology and we retrospectively determined posterior versus prior probabilities of inflammatory airway disorders. Moreover, in a prospective part comprising 108 patients, pneumologists rated their confidence in a given diagnosis before and after knowing sputum cytology and rated its impact on the diagnostic process on an analogue scale.
  
  
  RESULTS
  Among the 481 patients, 45% were diagnosed as having asthma and/or airway hyperresponsiveness. If patients showed sputum eosinophilia, the prevalence of this diagnosis was elevated to 73% (n = 109, p < 0.001). The diagnosis of COPD increased from 40 to 66% in patients with neutrophilia (n = 29, p < 0.01).Thirty-three of the 108 patients were excluded from the prospective part (26 insufficient samples, 7 incomplete questionnaires). In 48/75 cases the confidence into a diagnosis was raised after knowing sputum cytology, and in 15/75 cases the diagnosis was changed as cytology provided new clues.
  
  
  CONCLUSIONS
  Our data suggest that spontaneous sputum cytology is capable of assisting in the diagnosis of inflammatory airway diseases in the outpatient setting. Despite the limitations by the semiquantitative assessment and lower sputum quality, the supportive power and the low economic effort needed can justify the use of this method, particularly if the diagnosis in question is thought to have an allergic background.
authors.affiliation: Hospital Grosshansdorf, Center for Pneumology and Thoracic Surgery, 22927 Grosshansdorf, Germany. olaf.holz@t-online.de
authors.forename: Olaf
authors.initials: O
authors.lastname: Holz
authors.forename: Tanja
authors.initials: T
authors.lastname: Seiler
authors.forename: Andreas
authors.initials: A
authors.lastname: Karmeier
authors.forename: Jan
authors.initials: J
authors.lastname: Fraedrich
authors.forename: Helmut
authors.initials: H
authors.lastname: Leiner
authors.forename: Helgo
authors.initials: H
authors.lastname: Magnussen
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Jörres
authors.forename: Lutz
authors.initials: L
authors.lastname: Welker
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology*; D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D004802:Eosinophilia; D006801:Humans; D007958:Leukocyte Count; D009504:Neutrophils / Q000166:cytology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis; D012189:Retrospective Studies; D013183:Sputum / Q000166:cytology*