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Correspondence |

Sputum Induction for Diagnosis of Pulmonary Tuberculosis: Ready for Prime Time? FREE TO VIEW

Donald C. Vinh, MD; Dick Menzies, MD
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Affiliations: Winnipeg, MB, Canada,  Montreal, QC, Canada

Correspondence to: Donald C. Vinh, MD, Section of Infectious Diseases, University of Manitoba, 543–730 William Ave, Winnipeg, MB, Canada, R3E 0W3; e-mail: don_vinh@yahoo.com



Chest. 2006;130(5):1626. doi:10.1378/chest.130.5.1626
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To the Editor:

In his review of the clinical applications of induced sputum, Dr. Brightling1 states that “sputum induction provides a real alternative to bronchoscopy and BAL in the diagnosis of pulmonary tuberculosis.” However, it is the clinical utility of serial sputum induction as a primary diagnostic modality for pulmonary tuberculosis (TB) that should be emphasized.

In the diagnosis of pulmonary TB, sputum induction has been shown to have a better diagnostic yield than spontaneous sputum and gastric aspirates. Sputum induction fell into disuse, though, with the advent of fiberoptic bronchoscopy, which has become the primary method in many institutions. However, several studies23 have demonstrated that the diagnostic yield of one induced sputum is at least equivalent to that of one bronchoscopy with BAL, both in terms of acid-fast smear and mycobacterial culture. The diagnostic yield of induced sputa is further increased when multiple (three or more) specimens are obtained, with reported detection rates by smear of 91 to 98% and by culture of 99 to 100%,4significantly higher than with bronchoscopy alone.5 Induced sputum is a very well-tolerated procedure, with extremely low rates of adverse events (most commonly, headache, and bronchospasm/cough). Bronchoscopy has the inherent risks of an invasive procedure requiring a sedative. Both procedures must be performed in an airborne infection isolation room with respiratory protective equipment to minimize the risk of nosocomial transmission. Cost analysis studies2,5 also favor sputum induction over bronchoscopy.

Sputum induction can also be used effectively to diagnose other infections, such as Pneumocystis jiroveci pneumonia, and for assessment of other pulmonary conditions, including malignancy, interstitial lung diseases, and granulomatous diseases (eg, sarcoidosis). Thus, the rationale of performing bronchoscopy with BAL because of the perceived improved diagnostic yield in noninfectious pulmonary conditions may not always be valid. Rather than an “alternative” test, as described by Dr. Brightling, serial induced sputa should be considered as an inexpensive, and safe, primary diagnostic modality.

The authors have no financial or other potential conflicts of interest.

Brightling, CE (2006) Clinical applications of induced sputum.Chest129,1344-1348. [CrossRef]
 
Anderson, C, Inhaber, N, Menzies, D Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculosis.Am J Respir Crit Care Med1995;152,1570-1574. [CrossRef]
 
Conde, MB, Soares, SL, Mello, FC, et al Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis.Am J Respir Crit Care Med2000;162,2238-2240. [CrossRef]
 
Al Zahrani, K, Al Jahdali, H, Poirier, L, et al Yield of smear, culture and amplification tests from repeated sputum induction for the diagnosis of pulmonary tuberculosis.Int J Tuberc Lung Dis2001;5,855-860
 
McWilliams, T, Wells, AU, Harrison, AC, et al Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis.Thorax2002;57,1010-1014. [CrossRef]
 

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References

Brightling, CE (2006) Clinical applications of induced sputum.Chest129,1344-1348. [CrossRef]
 
Anderson, C, Inhaber, N, Menzies, D Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculosis.Am J Respir Crit Care Med1995;152,1570-1574. [CrossRef]
 
Conde, MB, Soares, SL, Mello, FC, et al Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis.Am J Respir Crit Care Med2000;162,2238-2240. [CrossRef]
 
Al Zahrani, K, Al Jahdali, H, Poirier, L, et al Yield of smear, culture and amplification tests from repeated sputum induction for the diagnosis of pulmonary tuberculosis.Int J Tuberc Lung Dis2001;5,855-860
 
McWilliams, T, Wells, AU, Harrison, AC, et al Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis.Thorax2002;57,1010-1014. [CrossRef]
 
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