الفهرس 
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Abstract
The aim of this study is to identify and compare possible changes in the cellular composition of induced sputum between samples obtained sequentially (three periods of 5 minutes each) during one sputum induction among asthmatic and COPD patients. A total of 48 participants were enrolled into the study and were divided into three groups. Group A included a total of 16 asthmatic patients – one of them was discontinued after decline in FEV1 more than 20% from baseline and were treated accordingly, group B included a total of 16 COPD patients while group C included 16 health participants. Sputum induction was performed for all subjects using isotonic saline and sputum samples were processed for estimation of total cell count and differential (Macrophages, neutrophils and eosinophils as percentage of total cell count).
All of the studied participants in the three groups were matched as regards to age and sex. Most of the studied individuals were males particularly in COPD group (87.5%) and 56.3% among healthy participants and 53.3% among asthmatic individuals. All of asthmatic and healthy participants were nonsmokers. Mean smoking index among COPD patients was estimated to be 41.1 pack year.
As regard to the most common chronic disease among the studied patients was diabetes mellitus (documented among 18.8% of COPD patients and 33.3% of asthmatics). 87.5% of the healthy participants have no history of any chronic diseases.
In the three groups there was no significant decrease in FEV1. Only one asthmatic patient showed decline in FEV1 by more than 20% from baseline value and he was discontinued from the study.
Comparison of total cell count between three groups has shown that COPD is associated with significantly higher total cell count when compared to asthmatics or healthy participants. Among the three groups total cell count decreased in examined sputum sample with progression in time of sputum induction process. The same difference is observed when comparing the total cell count in mixed sample.
As regard to differential cell count, our data have shown that COPD have higher neutrophilc content while asthmatics have shown eospinophilic content significantly higher than that of both COPD and health subjects.
No statistically significant difference was noted between the three consecutive samples (5, 10 and 15 minutes samples) and mixed sample as regard to total cell count as well as percentage of different cellular composition.
Among COPD patients, we have found that total cell count and percentage of neutrophils estimated in all sputum samples has significant positive correlation with smoking index. Percentage of neutrophils in sputum samples of COPD patients have been found to be negatively correlated with FEV1. Also, it was estimated that FEV1 is negatively correlated with smoking index among the studied COPD patients. Among asthmatic patients, FEV1 was found to be negatively correlated with total cell count and percentage of eosinophils.
Based on the previous findings, it can be concluded that sputum induction is safe non invasive procedure that is effective as clinical and research tool. Also, the current research has shown that fifteen minutes induction procedure with isotonic saline and processing of the mixed sample can be recommended for clinical settings and clinical trials. Significant correlation between FEV1 and cell count (total and differential) support the current evidences that sputum induction can be used as a clinical tool for monitoring and follow up of different pulmonary diseases as COPD and asthma.