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Review
. 2024 Aug 14;13(16):1355.
doi: 10.3390/cells13161355.

Breath and Sputum Analyses in Asthmatic Patients: An Overview

Piera Soccio  1 , Carla Maria Irene Quarato  2 , Pasquale Tondo  1   2 , Donato Lacedonia  1   2 , Anela Hoxhallari  1   2 , Maria Pia Foschino Barbaro  1   2 , Giulia Scioscia  1   2
Affiliations
Review

Breath and Sputum Analyses in Asthmatic Patients: An Overview

Piera Soccio et al. Cells. .

Abstract

Recent advancements in asthma management include non-invasive methodologies such as sputum analysis, exhaled breath condensate (EBC), and fractional exhaled nitric oxide (FeNO). These techniques offer a means to assess airway inflammation, a critical feature of asthma, without invasive procedures. Sputum analysis provides detailed insights into airway inflammation patterns and cellular composition, guiding personalized treatment strategies. EBC collection, reflecting bronchoalveolar lining fluid composition, provides a non-invasive window into airway physiology. FeNO emerges as a pivotal biomarker, offering insights into eosinophilic airway inflammation and aiding in asthma diagnosis, treatment monitoring, and the prediction of exacerbation risks. Despite inherent limitations, each method offers valuable tools for a more comprehensive assessment of asthma. Combining these techniques with traditional methods like spirometry may lead to more personalized treatment plans and improved patient outcomes. Future research is crucial to refine protocols, validate biomarkers, and establish comprehensive guidelines in order to enhance asthma management with tailored therapeutic strategies and improved patient outcomes.

Keywords: EBC; FeNO; airway inflammation; asthma management; non-invasive methods; sputum.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Induced sputum sampling. After spirometric evaluation and pretreatment with 200–400 μg of salbutamol, the patient inhales nebulized hypertonic saline solution, which liquefies airway secretions and allows the expectoration of respiratory secretions.
Figure 2
Figure 2
Representation of the theoretical influence of the induction time on the sampling of sputum at different levels of the respiratory tree.
Figure 3
Figure 3
Graphical representation of induced sputum processing.
Figure 4
Figure 4
Summary of the analyses that can be performed on a processed sputum sample.
Figure 5
Figure 5
Exhaled breath condensate (EBC) sampling. The patient, wearing a soft nose clip and in a sitting position, breathes at tidal volume through the mouth into a sampling device equipped with a mouthpiece that passes into a condensing cooling chamber, in whose walls the water vapor condenses.
Figure 6
Figure 6
Summary of the analyses that can be carried out on a sample of exhaled breath condensate (EBC).
Figure 7
Figure 7
Graphical representation of iNOS and cNOS involvement on NO production under physiological (left) and pathological (right) conditions in airway epithelial cells.
Figure 8
Figure 8
Representation of the theoretical influence of different constant expiratory flows on the sampling of FeNO values at different levels of the respiratory tree. ATS/ERS guidelines recommend an expiratory flow rate of 50 mL/s (FeNO50) as it allows targeting the lower respiratory tract as the region of interest for NO excretion.
See this image and copyright information in PMC

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