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SSIMPLE showed high reproducibility, strong correlation and agreement with DTT, accurate eosinophilia detection, and effective monitoring of monoclonal antibody treatment responsiveness.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/a-novel-method-to-assess-airway-eosinophilia-using-sputum-plugs/434784/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/a-novel-method-to-assess-airway-eosinophilia-using-sputum-plugs/434784.png","ImageObject",300,407,{"name":42,"@type":43},"Đào","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What problem does SSIMPLE address compared with routine DTT sputum processing?","Question",{"text":63,"@type":64},"Routine DTT processing requires multiple steps, specialised lab access, same-day processing, trained personnel, and substantial processing time, limiting clinical applicability. SSIMPLE uses FFPE sputum plugs to simplify measurement of airway eosinophilia and expand access.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was airway eosinophilia defined and assessed in this study?",{"text":68,"@type":64},"Airway eosinophilia was defined as ⩾2.2% sputum eosinophils in DTT-processed samples. FFPE blocks were sectioned, stained, and differential cell counts were performed on nonsquamous cells, then results were compared with matched DTT-processed slides.",{"name":70,"@type":61,"acceptedAnswer":71},"How well did SSIMPLE agree with the standard DTT method?",{"text":72,"@type":64},"SSIMPLE demonstrated excellent interobserver reproducibility and strong correlation and agreement with DTT processing of eosinophil proportions. A SSIMPLE cut-off of 2.6% detected airway eosinophilia with high sensitivity and specificity, and showed strong agreement with the routine DTT method.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},434784,1790795821,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},1374402968488,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","ERJ OPEN RESEARCH ORIGINAL RESEARCH ARTICLE  \nZ. PATEL ET AL.  \nA novel method to assess airway eosinophilia using sputum plugs  \nZil Patel 1,4, Nadia Suray Tan2,4, Alex Huynh 2, Katherine Radford3, Nicola Calma3, Lisa Harper3, Snehal Somalwar3, Chynna Huang3, Melanie Kjarsgaard3, Anmar Ayoub2, Parameswaran Nair2 and Manali Mukherjee 2  \n1 Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton ON, Canada. 2 Department of Medicine, McMaster University, Hamilton ON, Canada. 3 Research Institute of St Joe’s, St Joseph’s Healthcare Hamilton, Hamilton ON, Canada. 4These authors contributed equally.  \nCorresponding author: Manali Mukherjee ([mukherj@mcmaster.ca](mukherj@mcmaster.ca))  \nShareable abstract (@ERSpublications)  \nSputum eosinophil counts are valuable in airway disease management, but current processing has logistical constraints. Novel FFPE sputum plugs are a practical, valid approach to measure airway eosinophilia – expanding access to eosinophil-guided care. [https://bit.ly/3IgBTfc](https://bit.ly/3IgBTfc)  \nCite this article as: Patel Z, Tan NS, Huynh A, et al. A novel method to assess airway eosinophilia using sputum plugs. ERJ Open Res 2026; 12: 00604-2025 [DOI: 10.1183/23120541.00604-2025] .  \nCopyright ©The authors 2026  \nThis version is distributed under the terms of the Creative Commons Attribution NonCommercial Licence 4 .0. For commercial reproduction rights and permissions contact [permissions@ersnet.org](permissions@ersnet.org)  \nThis article has an editorial commentary:  \n[https://doi.org/10.1183/](https://doi.org/10.1183/)[ ](https://doi.org/10.1183/)[23120541.00914-2025](23120541.00914-2025)  \nReceived: 2 May 2025  \nAccepted: 19 June 2025  \nAbstract  \nBackground Sputum cytology utilising routine dithiothreitol (DTT) processing is a well-established method to assess airway eosinophilia. However, the multi-step nature of this protocol requires substantial resources, thereby limiting its broader clinical applicability. To address this, we evaluated formalin-fixed, paraffin-embedded (FFPE) sputum plugs as a simplified method for measuring airway eosinophilia. Methods Excess sputum plugs from 113 patients with complex airway disease and 16 asthma patients on corticosteroid or monoclonal antibodies were fixed in 10% formalin and embedded in paraffin (SputumMinimising Processing, Maximising Clinical Outcomes (SSIMPLE) method) . FFPE blocks were sectioned, stained with haematoxylin and eosin, and assessed by four blinded observers, who performed a differential cell count on 400 total nonsquamous cells. Eosinophil proportions were then compared between matched FFPE and DTT-processed sputum slides. Airway eosinophilia was defined as ⩾2.2% sputum eosinophils in DTT-processed samples.  \nResults Of the 113 FFPE slides, 96% were adequate for cellular analysis, with 90% having matched DTT-processed sputum slides. The SSIMPLE method demonstrated excellent interobserver reproducibility (consistency: 0.975; agreement: 0.976) . Eosinophil proportions obtained from SSIMPLE and DTT processing were significantly correlated (ρ=0.9, p\u003C0.0001) and showed agreement (Bland–Altman,−0.38±9.51) . A cut-off of 2.6% detected airway eosinophilia with high sensitivity (85.4%) and specificity (93.0%) using the SSIMPLE method, showing strong agreement with the routine DTT method, as indicated by an area under the curve of 0.957 . Additionally, the method effectively assessed treatment responsiveness to monoclonal antibody therapy.  \nConclusion The SSIMPLE method is a reliable, noninferior approach to DTT processing for detecting airway eosinophilia in complex airway diseases, with high reproducibility and strong concordance in monitoring treatment responsiveness.  \nIntroduction  \nEosinophil infiltration and degranulation in the airways plays a critical role in the pathogenesis of complex airway diseases such as asthma and COPD, which affect over 500 million individuals worldwide [1] . Despite corticosteroid therap","cbCaig43wR3js0Mw","https://ap.wps.com/l/cbCaig43wR3js0Mw","pdf",923177,13,"English","# Abstract\n# Background\n## Eosinophils and the role of sputum cytology\n# Methods\n# Results\n# Conclusion\n# Introduction\n## Limitations of current DTT-based processing\n## Rationale for FFPE sputum plugs (SSIMPLE)","[{\"question\":\"What problem does SSIMPLE address compared with routine DTT sputum processing?\",\"answer\":\"Routine DTT processing requires multiple steps, specialised lab access, same-day processing, trained personnel, and substantial processing time, limiting clinical applicability. SSIMPLE uses FFPE sputum plugs to simplify measurement of airway eosinophilia and expand access.\"},{\"question\":\"How was airway eosinophilia defined and assessed in this study?\",\"answer\":\"Airway eosinophilia was defined as ⩾2.2% sputum eosinophils in DTT-processed samples. FFPE blocks were sectioned, stained, and differential cell counts were performed on nonsquamous cells, then results were compared with matched DTT-processed slides.\"},{\"question\":\"How well did SSIMPLE agree with the standard DTT method?\",\"answer\":\"SSIMPLE demonstrated excellent interobserver reproducibility and strong correlation and agreement with DTT processing of eosinophil proportions. A SSIMPLE cut-off of 2.6% detected airway eosinophilia with high sensitivity and specificity, and showed strong agreement with the routine DTT method.\"}]","A novel method to assess airway eosinophilia using sputum plugs | PDF",1790670567,33]