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Allergy Asthma Respir Dis. 2017 Nov;5(6):307-311. Korean.
Published online November 30, 2017.
© 2017 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
KAAACI Standardization Committee report on the procedure and application of induced sputum examination
Min-Hye Kim,1 Mi-Yeong Kim,2 Kyung-Hwan Lim,3 Min-Suk Yang,4 Woo-Jung Song,5 Jeongmin Lee,6 Dong In Suh,7 Yoo Seob Shin,8 Jae-Woo Kwon,9 Sae-Hoon Kim,10 Sang-Heon Kim,11 Byung-Jae Lee,12 Sang-Heon Cho,5 Jae-Woo Jung,13 and Korean Academy of Asthma, Allergy and Clinical Immunology Standardization Committee
1Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
2Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
3Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
4Department of Internal Medicine, Seoul Metropolitan Government: Seoul National University Boramae Medical Center, Seoul, Korea.
5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
6Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea.
7Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
8Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
9Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
10Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
11Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
12Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
13Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Correspondence to: Jae-Woo Jung. Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea. Tel: +82-2- 6299-1437, Fax: +82-2-825-7571, Email:
Received March 17, 2017; Revised September 06, 2017; Accepted September 08, 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (


Induced sputum and sputum cell count analysis is a test for the diagnosis of various respiratory diseases. In particular, it has long been used as an important biomarker in the diagnosis or characterization of asthma or eosinophilic bronchitis. Despite a relatively long history of this test, there has been no consensus report for conducting and interpreting the analyses in Korea. Based on this awareness and necessity, the Korean Academy of Asthma, Allergy and Clinical Immunology launched the Standardization Committee to review the international guidelines and the literature and to develop a consensus report on the diagnostic procedure and interpretation of the sputum induction test.

Keywords: Sputum; Induced sputum; Methods; Analysis


Fig. 1
Image of the sputum cells (×200). M, macrophage; N, neutrophil; E, eosinophil; EP, epithelial cell.
Click for larger imageDownload as PowerPoint slide


Table 5
Causes of increase in specific cell type of induced sputum examination
Click for larger imageClick for full tableDownload as Excel file


This research was supported by a fund (A092076) by Research of Korea Centers for Disease Control and Prevention.

1. Bickerman HA, Sproul EE, Barach AL. An aerosol method of producing bronchial secretions in human subjects: a clinical technic for the detection of lung cancer. Dis Chest 1958;33:347–362.
2. Pin I, Gibson PG, Kolendowicz R, Girgis-Gabardo A, Denburg JA, Hargreave FE, et al. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax 1992;47:25–29.
3. Fahy JV, Wong H, Liu J, Boushey HA. Comparison of samples collected by sputum induction and bronchoscopy from asthmatic and healthy subjects. Am J Respir Crit Care Med 1995;152:53–58.
4. Pizzichini E, Pizzichini MM, Efthimiadis A, Dolovich J, Hargreave FE. Measuring airway inflammation in asthma: eosinophils and eosinophilic cationic protein in induced sputum compared with peripheral blood. J Allergy Clin Immunol 1997;99:539–544.
5. al-Ali MK, Howarth PH. Nitric oxide and the respiratory system in health and disease. Respir Med 1998;92:701–715.
6. Weiszhar Z, Horvath I. Induced sputum analysis: step by step. Breathe 2013;9:300–306.
7. Cataldo D, Foidart JM, Lau L, Bartsch P, Djukanovic R, Louis R. Induced sputum: comparison between isotonic and hypertonic saline solution inhalation in patients with asthma. Chest 2001;120:1815–1821.
8. Efthimiadis A, Spanevello A, Hamid Q, Kelly MM, Linden M, Louis R, et al. Methods of sputum processing for cell counts, immunocytochemistry and in situ hybridisation. Eur Respir J Suppl 2002;37:19s–23s.
9. Spanevello A, Confalonieri M, Sulotto F, Romano F, Balzano G, Migliori GB, et al. Induced sputum cellularity. Reference values and distribution in normal volunteers. Am J Respir Crit Care Med 2000;162(3 Pt 1):1172–1174.
10. Belda J, Leigh R, Parameswaran K, O'Byrne PM, Sears MR, Hargreave FE. Induced sputum cell counts in healthy adults. Am J Respir Crit Care Med 2000;161(2 Pt 1):475–478.
11. Kim MY, Jo EJ, Lee SE, Lee SY, Song WJ, Kim TW, et al. Reference ranges for induced sputum eosinophil counts in Korean adult population. Asia Pac Allergy 2014;4:149–155.
12. Jatakanon A, Lim S, Barnes PJ. Changes in sputum eosinophils predict loss of asthma control. Am J Respir Crit Care Med 2000;161:64–72.
13. Pavord ID, Brightling CE, Woltmann G, Wardlaw AJ. Non-eosinophilic corticosteroid unresponsive asthma. Lancet 1999;353:2213–2214.
14. Green RH, Brightling CE, McKenna S, Hargadon B, Parker D, Bradding P, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet 2002;360:1715–1721.
15. Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180:59–99.
16. Lougheed MD, Lemiere C, Ducharme FM, Licskai C, Dell SD, Rowe BH, et al. Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. Can Respir J 2012;19:127–164.
17. Maestrelli P, Calcagni PG, Saetta M, Di Stefano A, Hosselet JJ, Santonastaso A, et al. Sputum eosinophilia after asthmatic responses induced by isocyanates in sensitized subjects. Clin Exp Allergy 1994;24:29–34.
18. Jayaram L, Parameswaran K, Sears MR, Hargreave FE. Induced sputum cell counts: their usefulness in clinical practice. Eur Respir J 2000;16:150–158.
19. Eltboli O, Brightling CE. Eosinophils as diagnostic tools in chronic lung disease. Expert Rev Respir Med 2013;7:33–42.
20. D'Urso V, Doneddu V, Marchesi I, Collodoro A, Pirina P, Giordano A, et al. Sputum analysis: non-invasive early lung cancer detection. J Cell Physiol 2013;228:945–951.
21. Olivieri D, D'Ippolito R, Chetta A. Induced sputum: diagnostic value in interstitial lung disease. Curr Opin Pulm Med 2000;6:411–414.
22. Bothamley GH, Ditiu L, Migliori GB, Lange C. TBNET contributors. Active case finding of tuberculosis in Europe: a Tuberculosis Network European Trials Group (TBNET) survey. Eur Respir J 2008;32:1023–1030.
23. LaRocque RC, Katz JT, Perruzzi P, Baden LR. The utility of sputum induction for diagnosis of Pneumocystis pneumonia in immunocompromised patients without human immunodeficiency virus. Clin Infect Dis 2003;37:1380–1383.