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Sputum induction in young cystic fibrosis patients
K De Boeck1, M Alifier, S Vandeputte
1Dept of Pediatrics, University of Leuven, Belgium.
Insights
Sputum induction is a safe and effective method for obtaining lower airway samples in children with cystic fibrosis (CF) who cannot spontaneously expectorate. This procedure helps guide antibiotic therapy for CF lung disease.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Cystic Fibrosis Research
Background:
- Lower airway cultures are crucial for guiding antibiotic therapy in cystic fibrosis (CF) lung disease.
- Children with CF often have difficulty producing spontaneous sputum for analysis.
Purpose of the Study:
- To evaluate the efficiency, safety, and acceptability of sputum induction in pediatric CF patients.
- To determine if sputum induction can provide adequate samples for microbiological analysis in non-expectorating CF children.
Main Methods:
- Nineteen pediatric CF patients (mean age 8.6 years) inhaled hypertonic saline (0.9-6%) after baseline lung function tests.
- Spirometry (FEV1) was measured before and after salbutamol administration.
- Procedure safety and acceptability were assessed via oxygen saturation monitoring, adverse event recording, and a visual analogue scale.
Main Results:
- All patients successfully produced secretions, with alveolar macrophages present in 16/19 samples.
- Minor, but significant, bronchoconstriction occurred (mean post-salbutamol FEV1 change -7% predicted).
- The procedure was generally safe (oxygen saturation >90%) and acceptable (mean VAS -1.23), with one discontinuation due to cough and wheeze.
Conclusions:
- Sputum induction is a feasible and safe method for obtaining respiratory samples in pediatric CF patients who do not spontaneously expectorate.
- This technique can aid in guiding appropriate antibiotic selection for CF lung infections.
- Further research may explore optimizing protocols for enhanced sample quality and patient comfort.
Abstract:
A culture from the lower airway secretions is the optimal sample to guide antibiotic therapy in cystic fibrosis (CF) lung disease. The authors therefore examined whether sputum induction is an efficient, safe and acceptable procedure in CF children without spontaneous expectorations. Nineteen patients were studied. Their mean age (range) was 8.6 yrs (4.3-15.2 yrs). Their mean forced expiratory volume in one second (FEV1) was 88% predicted (46-122%). NaCl solutions from 0.9-6% were inhaled, after baseline lung function tests before and after salbutamol. All patients did produce secretions. Alveolar macrophages were present in 16/19 induced samples. The procedure induced minor but significant bronchoconstriction: the mean change (range) in postsalbutamol FEV1 (% pred) was -7 (-24-16). Percutaneous oxygen saturation remained above 90% in all children. The test had to be discontinued in one child because of cough and wheeze. Acceptability of the procedure evaluated using a visual analogue scale from -7-7 showed a mean value (range) at the final concentration of -1.23 (-6.16-5.88). It is concluded that sputum induction is possible, safe and acceptable in cystic fibrosis children who do not expectorate spontaneously.