PURPOSE: To evaluate the role of inhaled salbutamol, inhaled ambroxol and inhaled N-acetyl cysteine in establishing microbiological diagnosis of tuberculosis in terms of sputum positivity by inducing sputum in patients with smear negative pulmonary tuberculosis or in patients with dry cough.
METHODS: A total of 239 patients were included in our study divided randomly into three groups of 80, 77 and 82 patients respectively. Inhaled salbutamol, ambroxol and N-acetyl cysteine were given to induce sputum in the three groups respectively. All the sputum samples were subjected to direct smear examination for acid fast bacilli after staining by Ziehl Neelsen staining.
RESULTS: In three groups, 91.25%, 87% and 93.9% patients produced adequate sputum after inhalation of salbutamol, ambroxol and N-acetyl cysteine respectively. Acid fast bacilli examination of the induced sputum showed sputum positivity in 52.05% patients in salbutamol group, 28.36% patients in ambroxol group and 33.76% patients in N-acetyl cysteine group.
CONCLUSIONS: Sputum induction improves the diagnostic yield for acid fast bacilli in patients unable to expectorate adequate sputum sample. Inhaled salbutamol can be used as an agent for sputum induction in place of hypertonic saline. Inhaled ambroxol and N-acetyl cysteine can also be used for sputum induction but they have a lower yield as compared to inhaled salbutamol.
CLINICAL IMPLICATIONS: Smear negative pulmonary tuberculosis patients or pulmonary tuberculosis patients with dry cough should be subjected to sputum induction as it can increase the diagnostic yield in terms of sputum positivity.
DISCLOSURE: The following authors have nothing to disclose: Ummul Baneen, Zuber Ahmed, Jamal Akhtar, Nafees Khan, Rakesh Bhargava, Mohammad Shameem
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