The yield of Acid-Fast Bacilli (AFB) and tuberculosis (TB) culture in the microbiologic diagnosis of childhood tuberculosis using sputum induction: A randomized controlled trial with interrupted time series

@#<p style="text-align: justify;"><strong>Objectives:</strong> This study aims to determine the diagnostic yield and safety of sputum induction with hypertonic saline in the microbiologic confirmation of childhood tuberculosis (TB) in a tertiary hospital in the Philippines.</p><p style="text-align: justify;"><strong>Methods:</strong> This is a randomized controlled trial with an interrupted time series in the control group. One hundred twelve (112) pediatric patients (4-18 years old) with clinical findings suggestive of TB were enrolled in the study. Patients were randomized into two groups composed of 56 patients each. Group A patients underwent sputum induction. Group B patients underwent spontaneous expectoration followed by sputum induction. The microbiologic yield for acid-fast bacilli and TB culture were determined and analyzed.</p><p style="text-align: justify;"><strong>Results:</strong> Among the patients randomized to Group A, microbiologic confirmation for TB was 8/56 patients (14.3%) after sputum induction. For patients randomized to Group B, microbiologic yield was 4/56 patients (7.1%) from spontaneous expectoration; after sputum induction, the microbiologic yield increased to 5/56 patients (8.9%). There is insufficient evidence of statistical significance in microbiologic yield on parallel analysis of the two separate groups (p=0.22). Furthermore, for patients randomized to Group B, the increase in microbiologic yield after sputum induction compared to spontaneous expectoration did not reach statistical significance (p=1.000). The procedure was well-tolerated among children; no serious adverse events were observed.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Sputum induction is a feasible and safe method of specimen collection for microbiologic diagnosis of TB among children. While the microbiologic yield increased after sputum induction compared to spontaneous expectoration, the additional yield does not seem to be significant.</p>

Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.

Role of Sputum Induction in Sputum Smear Negative and Chest X-Ray Suggestive of Pulmonary Tuberculosis

Background: Sputum induction is a procedure used forpatients who have difficulty in spontaneously producingsputum. So we have planned to conduct a study to find out therole of sputum induction in TB patients to increase the yield ofsputum smear positivity in sputum smear negative pulmonarytuberculosis patients and the role of sputum induction intuberculosis suspected patients having cough withoutexpectoration.Materials & Methods: The present study was carried out in 50patients admitted with clinical & radiological featuressuggestive of pulmonary tuberculosis in the Department of TB& Respiratory diseases, R.N.T Medical College, Udaipur. Studyprotocol includes detailed history, clinical examination, routineblood investigations including ESR, chest x-ray, sputuminduction and smear study by Ziehl-Neelson staining was doneto all the patients included in the study.Results: Our study showed that the total numbers of caseswere 50, among which 40 (80%) cases were in the age groupof below 60 years. Males in the study are 31 (62%) andfemales are 19 (38%). ESR was elevated to more than 30mm/hr in 46 (92%) cases and less than 30mm/hr in 4 (8%)cases. Sputum production were absent in 40 (80%) cases.Maximum 30 (60%) cases had moderate disease, 14 (28%)cases had minimal disease and 6 (12%) cases hadfar advanced disease on chest x-ray. 30 (60%) cases had nocavity on chest x-ray and 20 (40%)cases had cavity.30(60%)cases had bilateral disease (B/L) and 20 (40%) caseshad unilateral disease (U/L) on chest x-ray.Conclusion: We concluded that the identification of smearpositivity through sputum induction method with 3%hypertonicsaline that allows sampling of the airways in a noninvasivefashion and is a less expensive approach than the techniquelike bronchial biopsy, bronchoalveolar lavage and gastriclavage.

Metabolomic Analysis of Serum Glycerophospholipid Levels in Eosinophilic and Neutrophilic Asthma / 生物医学与环境科学（英文）

OBJECTIVE@#To compare the serum glycerophospholipid levels in the inflammatory subtypes of asthma by using targeted metabolomic analysis.@*METHODS@#Demographic and clinical data were collected from 51 patients with asthma between January 2015 and December 2015. Routine blood and sputum induction tests were performed. Eosinophilic asthma was defined as induced sputum containing ⪖ 3% eosinophils, and neutrophilic asthma, as induced sputum containing ⪖ 71% neutrophils. Serum metabolic glycerophospholipid profile was determined by liquid chromatography-mass spectrometry. Differences in glycerophospholipid levels between eosinophilic and non-eosinophilic asthma and between neutrophilic and non-neutrophilic asthma were analyzed using partial least squares discriminant analysis.@*RESULTS@#The serum lysophosphatidylglycerol level was significantly higher in the group with ⪖ 3% eosinophils in sputum than in the group with < 3% eosinophils in sputum. The area under the receiver-operating characteristic curve was ⪖ 70%. There was no significant difference in the serum metabolic glycerophospholipid profile between the group with sputum neutrophils ⪖ 71% and the group with sputum neutrophils < 71%.@*CONCLUSION@#Serum lysophosphatidylglycerol is produced abundantly in eosinophilic asthma and may be a biomarker of eosinophilic asthma. This information is helpful for identifying and tailoring treatment for the common asthma subtypes.

Diagnosis of Pulmonary Tuberculosis in less Sputum Producing or Sputum Smear Negative Cases: A Prospective Study in a Tertiary Care Hospital

Background: To Diagnosis of Pulmonary Tuberculosis in less Sputum Producing or Sputum Smear Negative Cases. Methods: 200 patients were included in this study with either no sputum or inadequate sputum (only saliva or sputum quantity < 2 ml) or whose initial two sputum smear examinations for AFB were negative, were included in the study. Results: Sputum induction was successful in 96% of patients who could produce adequate volume (> 2 ml). 4 males and 4 female patients having dry cough were unable to produce sputum even after induction. Overall, 47% of patients were found positive on smear examination after sputum induction. 68 patients out of 136 (50%), who were having sputum and were negative on routine smear examination, were found positive on induced sputum smear examination. Sputum induction was successful in confirmation of diagnosis in 40.62% (26/64) of patients who were having cough with no/inadequate sputum. Conclusion: This study revealed that this method useful and also enhance the sensitivity for diagnosis of tuberculosis. Background: To Diagnosis of Pulmonary Tuberculosis in less Sputum Producing or Sputum Smear Negative Cases. Methods: 200 patients were included in this study with either no sputum or inadequate sputum (only saliva or sputum quantity < 2 ml) or whose initial two sputum smear examinations for AFB were negative, were included in the study. Results: Sputum induction was successful in 96% of patients who could produce adequate volume (> 2 ml). 4 males and 4 female patients having dry cough were unable to produce sputum even after induction. Overall, 47% of patients were found positive on smear examination after sputum induction. 68 patients out of 136 (50%), who were having sputum and were negative on routine smear examination, were found positive on induced sputum smear examination. Sputum induction was successful in confirmation of diagnosis in 40.62% (26/64) of patients who were having cough with no/inadequate sputum. Conclusion: This study revealed that this method useful and also enhance the sensitivity for diagnosis of tuberculosis.

Safety of modified sputum induction in moderate-to-very severe COPD during exacerbation / 实用医学杂志

Objective To evaluate the safety of modified sputum induction in moderate to very severe COPD during exacerbation. Methods Ninety patients with moderate, severe or very severe COPD during exacerbation (27 with type Ⅰ and Ⅱ respiratory failure,18 with coronary heart disease, 38 with tachycardia) were chosen as research subjects. All the patients underwent induced sputum. During induction , all patients were given electrocardiographic monitoring and pulmonary function check every 5 minutes and FEV1, HR, SpO2 in the process of testing were recorded. Results Ninety patients underwent 224 sputum inductions progress, 222 were safety. Qualified sputum samples were collected for 216 times, sputum induction was successful in 96.43% of occasions. Heart rate rising and SpO2 reducing during sputum induction mainly occurred in the beginning 5 minutes, FEV1 did not change in the whole process. Conclusion Modified sputum induction can be safe through closely monitoring in patients with moderate-to-very severe COPD with exacerbation, even with type Ⅰ or typeⅡ respiratory failure. But the risk of sputum induction will increase if patients with coronary heart disease and tachyarrhythmia, especially within beginning 5 minutes of sputum induction.

Use of sputum induction for establishing diagnosis in suspected pulmonary tuberculosis.

Setting: Department of Tuberculosis and Chest Diseases, Pt. B.D. Sharma PGIMS, Rohtak. Aim: The study was undertaken to find out the yield in the diagnosis of the smear negative pulmonary tuberculosis by sputum induction with hypertonic saline. Methodology: 5ml hypertonic saline was administered through ultrasonic nebuliser for a maximum of 30 minutes. Results: One hundred patients suspected of pulmonary tuberculosis either smear negative with spontaneous sputum or having inadequate/no sputum were studied. Ninety-seven patients produced adequate amount of sputum after hypertonic saline induction. Thirty-eight were found positive for AFB on sputum microscopy after induction. Conclusions: Hypertonic saline induction produces better quality and adequate sputum, thereby increasing yield of smear positive pulmonary tuberculosis.

Side effects of inhalation of hyperosmotic saline on sputum induction in asthmatic patients / 第三军医大学学报

0 05). Excessive bronchoconstriction occurred in one patient (1/41, 2.44%). Nausea and vomiting, pharyngeal dryness and pharyngalgia, dizziness and headache, discomfort of chest, and so on were found in other 43 9% patients, but the side effects were mild and endurable. Conclusion Sputum induction after inhalation of short acting ? 2 agonist is safe for asthmatic patients in the remission stage.

Safety analysis of sputum induction in children with asthma / 重庆医科大学学报

0.05).Conclusion:Hypertonic saline sputum induction is a safe technique for asthmatic children.

Safety and effectivity of hypertonic saline on sputum induction in patients with asthma and chronic obstructive pulmonary disease / 医学研究生学报

0.05).The percentage of eosinophils in induced sputum in asthmatics(16.3?7.2)% was higher than those in healthy volunteers(0.7?0.6)% and in COPD(6.5?5.4)%(P