PURPOSE: About 50% cases of pulmonary tuberculosis either do not demonstrate AFB in their sputum smears or they have dry cough altogether. In such cases one finds it very difficult to reach final diagnosis. We carried out this study to know whether sputum production and AFB positivity can be increased by sputum induction using three different inhaled drugs, salbutamol, N-acetylcysteine and ambroxol.
METHODS: This study was conducted in the Department of Tuberculosis and Respiratory Diseases, J. N. Medical College, AMU, Aligarh, India. Four hundred patients of sputum negative pulmonary tuberculosis were included in this study and randomly divided into four groups of 100 patients each. Three groups were nebulized for 5 minutes with salbutamol, N-acetylcysteine and ambroxol respectively before getting sputum samples. Fourth group was considered as control group and sputum samples were obtained without induction. Sputum samples were examined for AFB by Zeihl Neelsen method.
RESULTS: Seventy eight percent, 80% and 77% patients had productive cough in salbutamol, N-acetylcysteine and ambroxol groups respectively. After induction 5%, 8% and 3% more patients produced sputum respectively. Thus the total numbers of patients who produced sputum after induction were 84%, 88% and 80% respectively. Out of these 18%, 16% and 13% patients respectively, demonstrated AFB in their sputum smears. In control group, 79% patients had productive cough and out of these 5% demonstrated AFB in sputum smears.
CONCLUSIONS: All the three drugs were found to be effective in sputum induction. N- acetylcysteine was more effective than salbutamol and significantly effective than ambroxol. Sputum positivity rates were also significantly higher in all induced sputum groups than in non-induced group. All the three drugs were equally effective as far as the AFB positivity rate was concerened.
CLINICAL IMPLICATIONS: Salbutamol, N-acetylcysteine and ambroxol are effective drugs in Sputum induction. Sputum positivity rate for AFB can also be increased by sputum induction.
DISCLOSURE: The following authors have nothing to disclose: Zuber Ahmad, Rakesh Bhargava, Deepak Pandey, Mohammad Shameem, Suresh Kumar
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