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Pamela D'Sylva¹, Daan Caudri^2,3, Nicole Shaw³

¹Department of Physiotherapy, Princess Margaret Hospital for Children, WA, Australia.

Pediatric Pulmonology

|December 2, 2016

Insights

Induced sputum (IS) is not sensitive or specific for detecting lower airway pathogens in young children with cystic fibrosis. Further research is needed to improve diagnostic accuracy in pediatric CF patients.

Area of Science:

Pediatric Pulmonology
Infectious Diseases
Respiratory Medicine

Background:

Induced sputum sampling is a promising method for lower airway samples in children.
Pediatric induced sputum collection requires pharyngeal suctioning, differing from adult methods.

Purpose of the Study:

To assess the sensitivity and specificity of induced sputum (IS) for detecting lower airway pathogens.
To compare IS diagnostic accuracy with and without airway clearance techniques in young children (<7 years) with cystic fibrosis (CF).

Main Methods:

Compared microbiological culture results of 61 paired induced sputum and bronchoalveolar lavage fluid samples.
Analyzed data from two cohorts: one without airway clearance, one with airway clearance.
Induced sputum was collected within 7 days of bronchoscopy.

Main Results:

Overall IS sensitivity was 36.8% and specificity was 69% in children with CF.
In subgroup analysis, IS with airway clearance showed 50% sensitivity and 60.9% specificity.
IS without airway clearance demonstrated 27.3% sensitivity and 78.9% specificity.

Conclusions:

Induced sputum lacks high sensitivity and specificity for routine surveillance of lower airway pathogens in young children with CF.
Current methods require improvement for reliable pathogen detection in pediatric cystic fibrosis patients.

Read full analysis

Abstract

Introduction:

Induced sputum sampling holds promise as a method for obtaining samples representative of the lower airways in young children. Collection of induced sputum samples in young children differs from older children and adults' as pharyngeal suctioning is often required. Our aim was to determine the sensitivity and specificity of induced sputum with and without airway clearance techniques to detect lower airway pathogens in children less than age 7 with cystic fibrosis.

Methods:

Microbiological culture results were compared between 61 paired induced sputum and bronchoalveolar lavage fluid samples from young children with cystic fibrosis. The first cohort received no airway clearance and the second cohort received airway clearance. Induced sputum was sampled within 7 days of bronchoscopy.

Results:

Median age (range) of participants was 3.3 years (0.9-6.7). Sensitivity and specificity (95%CI) of induced sputum was 36.8% (16.3, 61.6), and 69% (52.9, 82.4), respectively (N = 61). In subgroup analysis, induced sputum with (N = 31) and without airway clearance (N = 30) demonstrated sensitivity of 50% (15.7, 84.3) and 27.3% (6.0, 61.0), respectively, and specificity of 60.9% (38.5, 80.3), and 78.9% (54.4, 93.9), respectively.

Conclusion:

Induced sputum is not highly sensitive or specific as routine surveillance for detection of lower airway pathogens in young children with cystic fibrosis. Pediatr Pulmonol. 2017;52:182-189. © 2016 Wiley Periodicals, Inc.

Keywords:

bronchoscopy children cystic fibrosis induced sputum

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