Table 42.2.

Onset of PCP is insidious and progressive. After the sputum has been suspended in the PBS by repeated pipetting, the suspension is centrifuged at 1500 rev/min (380 g) for 10 minutes at 4°C.

Eosinophils can be monitored noninvasively by sputum examination, and the standardized hypertonic saline–induced.

Endoscopically, the alimentary side of a fistula itself of the ampulla of Vater can sometimes be cannulated to obtain a high-quality radiograph of the communicating biliary anatomy (Chatzoulis et al, 2007; Moreira et al, 1984; Stempfle & Diamantopoulos, 1976; Watkins et al, 1975). In older patients who do not have a productive cough, it may still be possible to induce sputum by the inhalation of an aerosol (especially an ultrasonic aerosol) of saline (hypertonic or isotonic).111 This procedure may place medical personnel at some risk, and they should be protected by appropriate procedures from the aerosol generated by the patient's cough. Induced sputum specimens may be useful in the diagnosis of diffuse lung diseases and certain infectious diseases such as tuberculosis. The difficulty in obtaining an adequate sputum sample, variation in preparation, levels of skill in interpretation, and the lack of a gold standard for the microbiologic diagnosis of pneumonia all contribute to these difficulties. The predominance of neutrophils in the acute asthmatic patients suggests that exacerbations may involve the chemoattraction of neutrophils. Guidelines for the management of adults with community-acquired pneumonia.

The sputum eosinophil count is responsive in that it increases when asthma worsens (e.g. Interpretation Normal Results.

Am J Respir Crit Care Med 1999;160:346-348. 42.2A). Studies investigating the role of sputum Gram stain and culture are both difficult to interpret and compare. Protocol for Sputum Induction Using Nebulized Hypertonic Saline.

In asthma and other airway diseases, such as COPD and chronic cough, analysis of induced sputum may prove to be a useful clinical tool in the assessment of underlying inflammation as part of the disease process and monitoring of therapeutic responses.12, Ester Boix, in Methods in Enzymology, 2001. The whole cell content of sputum is very much lower than that of NPS and autolysis of the cells begins very quickly after expectoration. You simply need to provide the sample for the lab to test. Pneumonia in the very old. Although some markers are markedly different in asthma and COPD, and studying these markers may provide useful information in research protocols, their use in clinical practice has not been shown to be superior to simple cell counts. The sensitivity of sputum cytology depends on the location of the malignant tumor: 46% to 77% of central lung cancers but only 31% to 47% of peripheral cancers are diagnosed by sputum cytology.13,14 Surprisingly, sensitivity is independent of tumor stage and histologic type.

Direct injection of contrast material is the best way to outline the normal and pathologic anatomy of the biliary tract (see Chapter 20). Sputum evaluation is not indicated in the routine diagnosis and care of the COPD patient. The translation of this strategy to acute asthma may be challenging because the patterns of cellular inflammation can change with asthma exacerbations. The sputum differential neutrophil count is reduced following treatment with the fixed dose combination inhaler seretide in patients with COPD [30]. Use of this Web site is subject to the medical disclaimer.

Specimens consisting merely of squamous cells, bacteria, and Candida organisms are unsatisfactory because they represent only oral contents. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. Clin Chest Med 1999;20:531-548. 6. The difficulty in obtaining an adequate sputum sample, variation in preparation, levels of skill in interpretation, and the lack of a gold standard for the microbiologic diagnosis of pneumonia all contribute to these difficulties.1. Sputum production is a common complaint in patients with inflammatory disorders of the airways, like asthma, cystic fibrosis, and chronic obstructive pulmonary disease (COPD). Where induced sputum cannot be obtained, flexible bronchoscopy with washings or bronchoalveolar lavage represents a good alternative with a diagnostic yield close to that of culture (Lewinsohn, 2017). Symptomatic bronchoconstriction is unusual in patients with COPD, even those with severe airflow obstruction [5]; sputum induction has also been carried out repeatedly and safely in patients with severe asthma [6]. Sputum samples can be stored at −70 °C before analysis.77, Meilan K. Han MD, MS, Stephen C. Lazarus MD, in Murray and Nadel's Textbook of Respiratory Medicine (Sixth Edition), 2016.

Sputum expectoration requires cooperation between the person obtaining the sample and the subject. The available evidence suggests that analysis of the sputum adds little to the care or outcomes of patients with CAP (strength of recommendation [SOR]: B, inconsistent results from non-randomized case control, case series, and a systematic review of disease-oriented evidence). Skerrett SJ. An ABG analysis is rarely indicated and is rarely useful clinically. See our Other Publications. Am J Med 1998;105:319-330.

Unfortunately, sputum specimens may be difficult to obtain from children.

Results revealed that patients with community-acquired pneumococcal pneumonia were able to produce a valid sputum sample (≥20 neutrophils, <10 squamous epithe-lial cells per low-power field) 70% of the time; the sensitivity of sputum Gram stain ranged from 15% to 69% (when reviewed by a lab technician); and specificity ranged from 11% to 100%.

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