Sputum Induction by Newer Inhalation Methods in Patients with Pulmonary Tuberculosis

Abstract

An evaluation of 1,605 inhalation procedures for stimulating production of sputum, paired with an equal number of gastric lavages, in tuberculosis patients of Glen Lake State Sanatorium has been presented. The five inhalants tested were: 10 per cent sodium chloride, sulful dioxide, pancreatic dornase, acetylcysteine, and sterile water. The 10 per cent solution of sodium chloride and sterile water were vaporized by a superheated aerosol nebulizer; the sulfur dioxide was released from a pressurized measured-dose vial; and the acetylcysteine and pancreatic dornase were administered from a standard glass nebulizer. Cultures of induced sputum obtained by the various inhalants yielded more positive findings than cultures of the gastrics with which they were paired. Fifteen minutes of nebulization with collection of sputum for up to a half hour appears to be the method of choice. Delayed gastric lavage cultures are inefficient with fewer positive results. However, gastrics continue to be indicated for mentally ill individuals, acutely ill patients, and children under the age of seven or eight years. The 10 per cent sodium chloride solution inhalations consistently yielded more positive cultures than did the gastrics with which they were paired, and this is now preferred in our hospital and out-patient clinic. The results of acetylcysteine and pancreatic dornase inhalations were encouraging, but these methods need further investigation. Sulfur dioxide inhalations for sputum induction are not recommended because of the possible danger resulting from repeated exposure to sulfur dioxide. Side effects from the various inhalations were minimal.