Indução de escarro
revisão de literatura e proposta de protocolo
Palavras-chave:
Escarro, Asma, Técnicas citológicas, Tuberculose, Fibrose císticaResumo
Desde a década de 80, a indução de escarro pela inalação de solução salina hipertônica tem sido usada com sucesso para diagnosticar pneumonia por Pneumocystis carinii em pacientes infectados pelo HIV. Em anos recentes, a indução de escarro e seu subseqüente processamento foram refinados como uma ferramenta de pesquisa não invasiva que fornece informações importantes sobre eventos inflamatórios nas pequenas vias aéreas, sendo usada para estudar várias doenças. Na asma, uma aplicação é para o uso de índices inflamatórios do escarro para aumentar nossa compreensão de complexos relacionamentos entre célula inflamatória, mediador e mecanismos das citocinas. Na doença pulmonar obstrutiva crônica, a avaliação do escarro pode ser usada como um teste de seleção antes de se decidir pelo tratamento a longo prazo com corticosteróide. Na tuberculose, a indução do escarro é uma ferramenta valiosa para o diagnóstico nos pacientes HIV soropositivos que não produzem escarro. A indução de escarro parece ser um meio relativamente seguro, não-invasivo de se obter secreções das vias aéreas de sujeitos com fibrose cística, especialmente aqueles que não produzem normalmente o escarro. Além disso, a indução do escarro também pode ser usada na tosse crônica e no câncer de pulmão. Geralmente, a indução é executada através dos nebulizadores ultra-sônicos, usando solução salina hipertônica. Recomenda-se que o escarro seja processado o mais cedo possível, com homogeneização completa pelo uso de ditiotreitol. Mostramos também neste artigo um exemplo de protocolo que emprega um nebulizador de fabricação nacional para induzir o escarro.
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Referências
Pitchenik AE, Ganjei P, Torres A, Evans DA, Rubin E, Baier H. Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Am Rev Respir Dis 1986;133(2):226-9.
Pin I, Gibson PG, Kolendowicz R, et al. Use of induced spu- tum cell counts to investigate airway inflammation in asthma. Thorax 1992;47(1):25-9.
Djukanovic R, Sterk PJ, Fahy JV, Hargreave FE. Standardised methodology of sputum induction and processing. Eur Respir J 2002; 37(Suppl):1s-2s.
Grootendorst DC, Sont JK, Willems LN, et al. Comparison of inflammatory cell counts in asthma: induced sputum vs bronchoalveolar lavage and bronchial biopsies. Clin Exp Al- lergy 1997;27(7):769-79.
Vignola AM, Rennard SI, Hargrave FE, et al. Future directions. Eur Respir J 2002;20(Suppl 37):51s-55s.
Pavord ID, Sterk PJ, Hargreave FE, et al. Clinical applications of assessment of airway inflammation using induced sputum. Eur Respir J 2002;37(Suppl):40s-3s.
Kelly MG, Brown V, Martin SL, Ennis M, Elborn JS. Com- parison of sputum induction using high-output and low-out- put ultrasonic nebulizers in normal subjects and patients with COPD. Chest 2002;122(3):955-9.
Peleman RA, Rytilâ PH, Kips JC, Joos GF, Pauwels RA. The cellular composition of induced sputum in chronic obstructive pulmonary disease. Eur Respir J 1999;13(4):839-43.
Cosio MG, Majo J, Cosio MG. Inflammation of the airways and lung parenchyma in COPD: role of T cells. Chest 2002;121(5 Suppl):160S-5S.
Confalonieri M, Mainardi E, Della Porta R, et al. Inhaled corticosteroids reduce neutrophilic bronchial inflammation in patients with chronic obstructive pulmonary disease. Thorax 1998;53(7):583-5.
Fujimoto K, Kubo K, Yamamoto H, Yamaguchi S, Matsuzawa Y. Eosinophilic inflammation in the airway is related to gluco- corticoid reversibility in patients with pulmonary emphysema. Chest. 1999;115(3):697-702.
Bourbeau J, Rouleau MY, Boucher S. Randomised controlled trial of inhaled corticosteroids in patients with chronic obstruc- tive pulmonary disease. Thorax 1998;53(6):477-82.
Mendella LA, Manfreda J, Warren CP, Anthonisen NR. Ster- oid response in stable chronic obstructive pulmonary disease. Ann Intern Med 1982;96(1):17-21.
Pizzichini E, Pizzichini MM, Gibson P, et al. Sputum eosi- nophilia predicts benefit from prednisone in smokers with chronic obstructive bronchitis. Am J Respir Crit Care Med 1998;158(5 Pt 1):1511-7.
Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Con- sensus statement. Global burden of tuberculosis: estimated in- cidence, prevalence, and mortality by country. JAMA 1999;282(7):677-86.
World Health Organization. Treatment of tuberculosis: guide- lines for national programs. Geneva: World Health Organiza- tion; 1993.
Conde MB, Soares SL, Mello FC, et al. Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tu- berculosis: experience at an acquired immune deficiency syn- drome reference center in Rio de Janeiro, Brazil. Am J Respir Crit Care Med 2000;162(6):2238-40.
Anderson C, Inhaber N, Menzies D. Comparison of sputum in- duction with fiber-optic bronchoscopy in the diagnosis of tuber- culosis. Am J Respir Crit Care Med 1995;152(5 Pt 1):1570-4.
Zar HJ, Tannenbaum E, Apolles P, Roux P, Hanslo D, Hussey G. Sputum induction for the diagnosis of pulmonary tubercu- losis in infants and young children in an urban setting in South Africa. Arch Dis Child 2000;82(4):305-8.
Fraser RS, Paré JAP, Fraser RG, Paré PD. Diseases of the air- way. In: Fraser RS, Paré JAP, Fraser RG, Paré PD, eds. Synop- sis of diseases of the chest. Philadelphia: WB Saunders; 1996:683-87.
Sagel SD, Kapsner R, Osberg I, Sontag MK, Accurso FJ. Air- way inflammation in children with cystic fibrosis and healthy children assessed by sputum induction. Am J Respir Crit Care Med 2001;164(8 Pt 1):1425-31.
Henig NR, Tonelli MR, Pier MV, Burns JL, Aitken ML. Spu- tum induction as a research tool for sampling the airways of subjects with cystic fibrosis. Thorax 2001;56(4):306-11.
Kovacs JA, Gill VJ, Meshnick S, Masur H. New insights into transmission, diagnosis, and drug treatment of Pneumocystis carinii pneumonia. JAMA 2001;286(19):2450-60.
Kirsch CM, Azzi RL, Yenokida GG, Jensen WA. Analysis of induced sputum in the diagnosis of Pneumocystis carinii pneu- monia. Am J Med Sci 1990;299(6):386-91.
Metersky ML, Aslenzadeh J, Stelmach P. A comparison of in- duced and expectorated sputum for the diagnosis of Pneumocystis carinii pneumonia. CHEST 1998;113(6):1555-9.
Paggiaro PL, Chanz P, Holtz O, et al. Sputum induction. Eur Respir J 2002;20(Suppl 37):3s-8s.
Smith CM, Anderson SD. Inhalation provocation tests using nonisotonic aerosols. J Allergy Clin Immunol 1989;84(5 Pt 1):781-90.
Wong HH, Fahy JV. Safety of one method of sputum induc- tion in asthmatic subjects. Am J Respir Crit Care Med 1997;156(1):299-303.
Pavia D, Thomson ML, Clarke SW. Enhanced clearance of se- cretions from the human lung after the administration of hyper- tonic saline aerosol. Am Rev Respir Dis 1978;117(2):199-203.
Bacci E, Cianchetti S, Paggiaro PL, et al. Comparison between hypertonic and isotonic saline-induced sputum in the evalua- tion of airway inflammation in subjects with moderate asthma. Clin Exp Allergy 1996;26(12):1395-400.
Bacci E, Cianchetti S, Ruocco L, et al. Comparison between eosinophilic markers in induced sputum and blood in asthmatic patients. Clin Exp Allergy 1998;28(10):1237-43.
Bartoli ML, Bacci E, Carnevali S, et al. Quality evaluation of samples obtained by spontaneous or induced sputum: compari- son between two methods of processing and relationship with clinical and functional findings. J Asthma 2002;39(6):479-86.
Pizzichini E, Pizzichini MM, Efthimiadis A, Hargreave FE, Dolovich J. Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary con- tamination. Eur Respir J 1996;9(6):1174-80.
Fahy JV, Liu J, Wong H, Boushey HA. Cellular and biochemi- cal analysis of induced sputum from asthmatic and from healthy subjects. Am Rev Respir Dis 1993;147(5):1126-31.
Gershman NH, Wong HH, Liu JT, Mahlmeister MJ, Fahy JV. Comparison of two methods of collecting induced sputum in asthmatic subjects. Eur Respir J 1996;9(12):2448-53.
Efthimiadis A, Spanevello A, Hamid Q, et al. Methods of sputum processing for cell counts, immunocytochemistry and in situ hybridisation. Eur Respir J 2002; 37(Suppl):19s-23s.
Pizzichini E, Pizzichini MM, Efthimiadis A, et al. Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements. Am J Respir Crit Care Med 1996;154(2 Pt 1):308-17.
Popov T, Gottschalk R, Kolendowicz R, Dolovich J, Powers P, Hargreave FE. The evaluation of a cell dispersion method of sputum examination. Clin Exp Allergy 1994;24(8):778-83.
Woltmann G, Ward RJ, Symon FA, Rew DA, Pavord ID, Wardlaw AJ. Objective quantitative analysis of eosinophils and bronchial epithelial cells in induced sputum by laser scanning cytometry. Thorax 1999;54(2):124-30.
Vianna EO, Matos FL, Martinez JAB, Terra-Filho J. Sputum induction in asthma. Comparison of two ultrasonic nebulizers [abstract]. ATS 2001, 2002 & 2003. 3 Year Abstracts 2 ViewTM. Available from: URL: http://www.abstracts2view.com/atsall/search.php?search=do&intMaxHits=10&where%5B%5D=&andornot%5B%5D=&query=Vianna. Accessed on 22/07/03.
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