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Editorials: POINT/COUNTERPOINT EDITORIALS |

Counterpoint: Is Measuring Sputum Eosinophils Useful in the Management of Severe Asthma? No, Not for the Vast Majority of Patients

Stephen P. Peters, MD, PhD, FCCP
Author and Funding Information

From the Center for Genomics and Personalized Medicine Research, Wake Forest Health Sciences.

Correspondence to: Stephen P. Peters, MD, PhD, FCCP, Wake Forest University Health Sciences, Center for Genomics and Personalized Medicine Research, Medical Center Blvd, Winston-Salem, NC 27157; e-mail: sppeters@wfubmc.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Peters has been a member of the Wake Forest Clinical Trials Group, which has performed clinical trials for Ception/Cephalon, GlaxoSmithKline, and Medimmune examining the effect of anti-IL5 therapies in patients with severe asthma.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1273-1275. doi:10.1378/chest.11-0627
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Extract

Quantitating airway inflammation in patients with asthma by noninvasive methods, mainly by enumerating inflammatory cells such as eosinophils in induced sputum, has provided unique information concerning both asthma pathogenesis and the airway response to treatment. Although it is possible for highly specialized centers to reliably induce, process, and quantitate inflammatory cells and markers in sputum,1 the procedure is time and labor intensive (it takes a skilled coordinator or technician about one-half day), requires meticulous attention to detail, and is expensive (the most expensive procedure done in the Asthma Clinical Research Network of the National Heart, Lung and Blood Institute [NHLBI], except bronchoscopy). Largely for these reasons, a recent meta-analysis concluded that “At present, there is insufficient justification to advocate the routine use of…sputum analysis (due to technical expertise required)…in everyday clinical practice” for tailor­ing asthma treatment.2 Although the data discussed in the meta-analysis that support this conclusion should end this debate, the answers to the following five questions provide an additional perspective on this issue.

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