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Comparative analysis of induced sputum and bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers

Evangelos C Alexopoulos12*, Demosthenes Bouros3, Maria Dimadi4, Aneta Serbescu5, Giorgos Bakoyannis2 and Fivos P Kokkinis6

Author Affiliations

1 Occupational Health Unit, Department of Public Health, Medical School, University of Patras, GR-26500 Rio Patras, Greece

2 Medical School, Athens University, Athens, Greece

3 Department of Pulmonology, Medical School, Democritus University of Thrace, Greece

4 Department of Pulmonology, 'SOTIRIA' Chest Hospital, Athens, Greece

5 Institute of Pulmonology 'M. Nasta', Bucharest, Romania

6 Pulmonology Clinic, General Hospital of Lamia, Greece

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Journal of Occupational Medicine and Toxicology 2011, 6:23  doi:10.1186/1745-6673-6-23

Published: 14 August 2011



Biological monitoring of healthy workers exposed to hazardous dusts lack validated screening tools. Induced sputum (IS) cellular profile was compared with bronchoalveolar lavage fluid (BALF) profile in asbestos exposed workers in order to assess its usefulness in monitoring workers exposed to asbestos for a long period of time.


IS and BALF analysis was performed in 39 workers of a car brakes and clutches factory that uses chrysotile asbestos. Selection criteria were an employment history of > 15 years and the absence of a diagnosis of pneumonoconiosis. The type of cells, the existence of dust cells, of iron laden macrophages and of asbestos bodies were assessed and compared between IS and BALF samples.


35 IS samples (90%) had dust cells, 34 (87%) iron laden macrophages and in 8 samples (21%) asbestos bodies were found. In most samples neutrophils were dominated. Samples with asbestos bodies (ABs) had significantly higher lymphocytes and lower neutrophils count compared with the samples without ABs. Macrophages and neutrophils in IS and BALF exhibited significant inter-relations (Spearman's rho: 0.26-0.29, p < 0.05) while IS lymphocytes count showed an inverse relation with BALF neutrophils (Spearman's rho: -0.36). Neutrophils and dust cells were highly correlated between the samples (Spearman's rho: 0.35, p < 0.05) while IS dust cells and lymphocytes were inversely related (Spearman's rho: -0.36, p < 0.05). More years of employment in the company was related with more neutrophils (Spearman's rho: 0.26) and less lymphocytes (Spearman's rho: -0.33) count. In multivariate analysis the presence of AB in IS samples was strongly related to the presence of asbestos bodies and lymphocytes count in BALF samples.


IS and BALF analysis showed a similar cellular profile indicating that IS sampling in exposed workers to asbestos as a less invasive and expensive method may be useful in providing an insight both for inhalation of dusts and inflammatory processes in the lung.