Arrhythmias as trigger for acute exacerbations of chronic obstructive pulmonary disease.

Respir Med. 2012 May 15;

Authors: Bhatt SP, Nanda S, Kintzer JS

Abstract
PURPOSE: Acute exacerbations of chronic obstructive pulmonary disease (COPD) sometimes appear to occur without a precipitating cause. Heterogeneous repolarization and arrhythmias occur in COPD patients. Given the close inter-relation between heart and lung, we hypothesized that unrecognized arrhythmias might be precipitants of acute exacerbations. METHODS: Electrocardiograms (ECG) of thirty patients during acute exacerbations were compared with ECG during stable phase. P wave dispersion was used to assess atrial depolarization heterogeneity, and dispersion of QT interval to assess ventricular repolarization. p < 0.05 was considered significant. Frequent exacerbations were defined as two or more exacerbations in a year. RESULTS: Mean age of patients was 70.3 ± 11.8 SD years. P wave dispersion was greater during acute exacerbation than during stable phase (56.7 ± 19.2 vs 47.7 ± 15.9 ms, p = 0.009). There was a trend toward greater QTc dispersion (108.3 ± 61.7 vs 90.3 ± 47.0 ms, p = 0.13) in acute exacerbation compared to stable phase. Sixteen (53%) had frequent exacerbations. There was a significant difference in PR interval during stable phase between those with frequent exacerbations and those without (163.9 + 17.4 vs. 145.1 + 22.8; p = 0.02). The P wave dispersion during stable phase was greater in those with frequent exacerbations, but did not reach statistical significance (52.6 + 18.8 vs. 42.2 + 9.8 ms; p = 0.06). CONCLUSIONS: P wave dispersion is more in the acute phase than in stable phase, and is greater in patients with more frequent exacerbations. This does not prove, but suggests an intriguing possibility that P wave dispersion predates acute exacerbations. This might be a new target for prediction, prevention and therapy of acute exacerbations of COPD.

PMID: 22595809 [PubMed - as supplied by publisher]

All Danish first-time COPD hospitalisations 2002-2008: incidence, outcome, patients, and care.

Respir Med. 2012 Apr;106(4):549-56

Authors: Lykkegaard J, Søndergaard J, Kragstrup J, Rømhild Davidsen J, Knudsen T, Andersen M

Abstract
OBJECTIVE: This study aimed to investigate trends in first-time hospitalisations with chronic obstructive pulmonary disease (COPD) in a publicly financed healthcare system during the period from 2002 to 2008 with respect to incidence, outcome and characteristics of hospitalisations, departments, and patients.
METHODS: Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed.
RESULTS: During the period 2002 to 2008 the total rate of COPD hospitalisations decreased from 460 to 410 per 100,000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI 1.01-1.34) and the one-year mortality increased OR 1.12 (95% CI 1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased.
CONCLUSION: Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study.

PMID: 22115929 [PubMed - indexed for MEDLINE]

Endemic mycoses: Overlooked causes of community acquired pneumonia.

Respir Med. 2012 Mar 2;

Authors: Hage CA, Knox KS, Wheat LJ

Abstract
The endemic mycoses are important but often overlooked causes for community acquired pneumonia. Delays in recognition, diagnosis and proper treatment often lead to disastrous outcomes. This topic is not usually discussed in reviews and guidelines addressing the subject of community acquired pneumonia. In this review we discuss the three major endemic mycoses in North America that present as community acquired pneumonias; Coccidioidomycosis, Histoplasmosis and Blastomycosis. We discuss their epidemiology, clinical presentations, methods of diagnosis and current treatment strategies.

PMID: 22386326 [PubMed - as supplied by publisher]

Clinical characteristics and prognosis of chronic pulmonary aspergillosis.

Respir Med. 2012 Feb 18;

Authors: Ohba H, Miwa S, Shirai M, Kanai M, Eifuku T, Suda T, Hayakawa H, Chida K

Abstract
BACKGROUND: The details of the clinical characteristics of patients with chronic pulmonary aspergillosis (CPA) have not been fully understood. METHOD: One hundred twenty-nine consecutive patients with isolation of Aspergillus species by culture from respiratory specimens who attended our hospital between October 2001 and September 2009 were enrolled. Patients diagnosed with chronic pulmonary aspergillosis (CPA) were retrospectively reviewed for clinical characteristics and prognosis, compared with patients with Aspergillus species colonization. RESULTS: Forty-two (32.6%) were diagnosed with CPA, whereas 87 (67.4%) with colonization. Aspergillus fumigatus was significantly more frequently detected in the CPA group than in the colonization group. Regarding underlying diseases, CPA patients had a significantly higher prevalence of a history of pulmonary tuberculosis and diabetes mellitus than colonization patients. There were no significant differences between the CPA and colonization group in Aspergillus antigen titers. Positivity for Aspergillus precipitating antibody was 74.3% in CPA and 15.8% in colonization, respectively. Sensitivity and specificity of Aspergillus precipitating antibody for the determination of CPA was 74.4% and 84.1%, respectively.Patients with CPA had significantly shorter survival than patients with colonization (mortality rate 50.0% vs. 13.8%, observation periods: 28.7 ± 26.6 months) (p < 0.0001). Multivariable analysis revealed that BMI was an independent predictor of prognosis (Odds Ratio, 1.973; p = 0.0223). CONCLUSIONS: CPA is a disease with a poor prognosis, which shows distinct clinical characteristics from colonization.

PMID: 22349065 [PubMed - as supplied by publisher]

Weight of the IDSA/ATS minor criteria for severe community-acquired pneumonia.

Respir Med. 2011 Oct;105(10):1543-9

Authors: Guo Q, Li HY, Zhou YP, Li M, Chen XK, Liu H, Peng HL, Yu HQ, Chen X, Liu N, Liang LH, Zhao QZ, Jiang M

Abstract
BACKGROUND: The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) when patients fulfilled three out of nine minor criteria. Whether each of the criteria is of equal weight is not clear. The purpose of this study was to determine the weight of the minor criteria.
METHODS: 1230 adult patients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.
RESULTS: Hospital mortality rose sharply from 0.3%, 1.0% and 3.3%, respectively, for patients with none, one and two minor criteria to 10.5% for patients with three minor criteria. Arterial oxygen pressure/fraction inspired oxygen (PaO(2)/FiO(2)) ? 250 mm Hg, confusion, and uremia had the strongest association with mortality (Odds ratio, 22.162, 22.148, 16.343; respectively). Leukopenia, hypothermia, and hypotension were not associated with mortality. Confusion and uremia showed independent relationships with mortality (Odds ratio, 9.296, 8.493; respectively). Sequential organ failure assessment (SOFA) scores and costs increased significantly with the number of minor criteria present. Uremia and PaO(2)/FiO(2) ? 250 mm Hg were most strongly associated with SOFA scores [rank correlation coefficient (r(s)), 0.352, 0.336; respectively]. PaO(2)/FiO(2) ? 250 mm Hg and confusion were in closest relation to hospital length of stay (LOS) (r(s), 0.114, 0.114; respectively). PaO(2)/FiO(2) ? 250 mm Hg and multilobar infiltrates were most strongly associated with costs (r(s), 0.257, 0.196; respectively).
CONCLUSIONS: The individual 2007 IDSA/ATS minor criteria for severe CAP were of unequal weight in predicting hospital mortality, SOFA scores, hospital LOS, and costs.

PMID: 21764276 [PubMed - indexed for MEDLINE]

Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia.

Respir Med. 2011 Nov;105(11):1732-8

Authors: Aliberti S, Ramirez J, Cosentini R, Brambilla AM, Zanaboni AM, Rossetti V, Tarsia P, Peyrani P, Piffer F, Blasi F

Abstract
BACKGROUND: The relationship between clinical judgment and indications of the CURB-65 score in deciding the site-of-care for patients with community-acquired pneumonia (CAP) has not been fully investigated. The aim of this study was to evaluate reasons for hospitalization of CAP patients with CURB-65 score of 0 and 1.
METHODS: An observational, retrospective study of consecutive CAP patients was performed at the Fondazione Cà Granda, Milan, Italy, between January 2005 and December 2006. The medical records of hospitalized patients with CAP having a CURB-65 score of 0 and 1 were identified and reviewed to determine whether there existed a clinical basis to justify hospitalization.
RESULTS: Among the 580 patients included in the study, 218 were classified with a CURB-65 score of 0 or 1. Among those, 127 were hospitalized, and reasons that justified hospitalization were found in 104 (83%) patients. Main reasons for hospitalization included the presence of hypoxemia on admission (35%), failure of outpatient therapy (14%) and the presence of cardiovascular events on admission (9.7%). Used as the sole indicator for inappropriate hospitalization, the CURB-65 score had a poor positive predictive value of 52%.
CONCLUSIONS: Although the CURB-65 has been proposed as a tool to guide the site of care decision by international guidelines, this score is not ideal by itself, and should not be regarded as providing decision support information if a score of 0 and 1 is present. In CAP patients with CURB-65 scores of 0 or 1, further evaluations should be performed and completed by clinical judgment.

PMID: 21821405 [PubMed - indexed for MEDLINE]

Inhaler mishandling is very common in patients with chronic airflow obstruction and long-term home nebuliser use.

Respir Med. 2012 Jan 23;

Authors: Melani AS, Canessa P, Coloretti I, Deangelis G, Detullio R, Deldonno M, Giacobbe R, Scarlato I, Serafini A, Barbato N, Vaghi A, Sestini P

Abstract
Inhalers and nebulisers are devices used for delivering aerosolised drugs in subjects with Chronic Airflow Obstruction (CAO). This multicentre, cross-sectional observational study was performed in a large population of outpatients with CAO regularly using home aerosol therapy and referring to chest clinics. The aims of the study were to compare the characteristics of the group of subjects with CAO who were using home nebulisers but also experienced with inhalers vs. those only using inhalers and to investigate whether the first group of subjects was particularly prone to inhaler misuse. Information was gained evaluating the responses to a standardised questionnaire on home aerosol therapy and the observations of inhaler technique. We enrolled 1527 patients (58% males; mean ± SE; aged 61.1 ± 0.4 years; FEV1% pred 69.9 ± 0.6; 51% and 44% respectively suffering from COPD and asthma) who were only inhaler users (OIU group) and 137 (85% males; aged 67.7 ± 1.3 years; FEV1% pred 62.3 ± 2.9; 60% and 23% respectively suffering from COPD and asthma) who were using both nebulisers and inhalers (NIU group). Nebuliser users were older, had more severe obstruction, related symptoms and health care resources utilisation. Nebulisers users performed more critical inhalers errors than those of the OIU group (49% vs. 36%; p = 0.009). We conclude that our patients with CAO and regular nebuliser treatment had advanced age, severe respiratory conditions and common inhaler misuse.

PMID: 22277996 [PubMed - as supplied by publisher]

Status asthmaticus in the medical intensive care unit: A 30-year experience.

Respir Med. 2011 Dec 20;

Authors: Peters JI, Stupka JE, Singh H, Rossrucker J, Angel LF, Melo J, Levine SM

Abstract
OBJECTIVES: To investigate the characteristics, trends in management (permissive hypercapnia; mechanical ventilation (MV); neuromuscular blockade) and their impact on complications and outcomes in Status Asthmaticus (SA). METHODS: We performed a retrospective observational study of subjects admitted with SA to a single multidisciplinary MICU over a 30-year period. All laboratory, radiologic, respiratory care, physician notes and orders were extracted from an electronic medical record (EMR) maintained during the entire duration of the study. RESULTS: Two hundred and twenty-seven subjects were admitted with 280 episodes of SA. While subjects reflected our regional population (52% Hispanic), African Americans were over-represented (22%) and Caucasians under-represented (21%). Thirty-eight percent reported childhood asthma, 27% were steroid dependent (10% in the last 10 years), and 18% had a recent steroid taper. One hundred and thirty-nine (61.2%) required intubation. The duration of hospitalization was similar between mechanically ventilated and non-ventilated subjects (5.8±4.41 vs. 6.8±7.22 days; p=0.07). The overall complication rate remained low irrespective of the use of permissive hypercapnia or mode of mechanical ventilation (overall mortality 0.4%; pneumothorax 2.5%; pneumonia 2.9%). The frequency of SA declined significantly in the last 10 years of the study (12.4 vs. 3.2 cases/year). CONCLUSIONS: Despite the frequent use of mechanical ventilation, mortality/complication rates remained extremely low. MV did not significantly increase the duration of hospitalization. At our institution, the frequency of SA significantly decreased despite an increase in emergency room visits for asthma.

PMID: 22188845 [PubMed - as supplied by publisher]

Computerized lung sound analysis as diagnostic aid for the detection of abnormal lung sounds: a systematic review and meta-analysis.

Respir Med. 2011 Sep;105(9):1396-403

Authors: Gurung A, Scrafford CG, Tielsch JM, Levine OS, Checkley W

Abstract
RATIONALE: The standardized use of a stethoscope for chest auscultation in clinical research is limited by its inherent inter-listener variability. Electronic auscultation and automated classification of recorded lung sounds may help prevent some of these shortcomings.
OBJECTIVE: We sought to perform a systematic review and meta-analysis of studies implementing computerized lung sound analysis (CLSA) to aid in the detection of abnormal lung sounds for specific respiratory disorders.
METHODS: We searched for articles on CLSA in MEDLINE, EMBASE, Cochrane Library and ISI Web of Knowledge through July 31, 2010. Following qualitative review, we conducted a meta-analysis to estimate the sensitivity and specificity of CLSA for the detection of abnormal lung sounds.
MEASUREMENTS AND MAIN RESULTS: Of 208 articles identified, we selected eight studies for review. Most studies employed either electret microphones or piezoelectric sensors for auscultation, and Fourier Transform and Neural Network algorithms for analysis and automated classification of lung sounds. Overall sensitivity for the detection of wheezes or crackles using CLSA was 80% (95% CI 72-86%) and specificity was 85% (95% CI 78-91%).
CONCLUSIONS: While quality data on CLSA are relatively limited, analysis of existing information suggests that CLSA can provide a relatively high specificity for detecting abnormal lung sounds such as crackles and wheezes. Further research and product development could promote the value of CLSA in research studies or its diagnostic utility in clinical settings.

PMID: 21676606 [PubMed - indexed for MEDLINE]

Effectiveness of discharge-coordinator intervention in patients with chronic obstructive pulmonary disease: study protocol of a randomized controlled clinical trial.

Respir Med. 2011 Oct;105 Suppl 1:S26-30

Authors: Farkas J, Kadivec S, Kosnik M, Lainscak M

Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) follows a slowly progressive natural course that can be accelerated by acute exacerbations, which frequently trigger admissions to hospital. Specific healthcare professional profiles such as that of discharge coordinator have been successful in reducing numbers of hospitalizations and need for medical care in patients with various chronic diseases, but data for COPD are sparse and inconclusive. This study was conceived to test whether coordinated discharge and post-discharge care could reduce re-hospitalizations and use of resources in patients with COPD.
METHODS/DESIGN: This ongoing single-center randomized controlled clinical trial, which began in November 2009, is enrolling COPD patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II IV, hospitalized because of acute exacerbation. Patients are randomized in a 1:1 fashion to the intervention group, which has care organized by a discharge coordinator, and a control group receiving the usual care. The primary endpoint of the study is the number of patients hospitalized because of worsening of COPD. Data are collected at baseline, at the time of hospital discharge, and at the following time-points after discharge: 48 hours, 7 10 days, 30 days, 90 days, and 180 days.
DISCUSSION: In COPD patients requiring hospital admission, coordinated discharge appears a feasible option for improving patient and healthcare system-related outcomes. This study will provide evidence on the effectiveness of a discharge coordinator in patients hospitalized because of acute exacerbation of COPD and may give relevant guidance for implementation in clinical practice. Clinical trial registration number: NCT01225627.

PMID: 22015082 [PubMed - in process]

Differences between bisoprolol and carvedilol in patients with chronic heart failure and chronic obstructive pulmonary disease: a randomized trial.

Respir Med. 2011 Oct;105 Suppl 1:S44-9

Authors: Lainscak M, Podbregar M, Kovacic D, Rozman J, von Haehling S

Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) frequently coexists in patients with chronic heart failure (CHF) and is a key factor for beta blocker underprescription and underdosing. This study compared effects of bisoprolol and carvedilol in patients with both conditions.
METHODS: This was a randomized open-label study, of bisoprolol and carvedilol during initiation and uptitration to target or maximal tolerated dose. Pulmonary function testing, 12-lead electrocardiogram, and N-terminal pro brain natriuretic peptide were measured at baseline and follow-up.
RESULTS: We randomized 63 elderly patients (73±9 years, 81% men, left ventricular ejection fraction 33±7%) with mild to moderate CHF (54% New York Heart Assocation class II) and moderate to severe COPD (76% Global initiative for chronic Obstructive Lung Disease stage 2). Target dose was tolerated by 31 (49%) patients and 19 (30%) patients experienced adverse events during follow-up (19% bisoprolol, 42% carvedilol, p = 0.045). Study medication had to be withdrawn in 8 (13%) patients (bisoprolol: 2 due to hypotension, 1 due to bradycardia; carvedilol: 2 due to hypotension and 1 due to wheezing, dyspnoea, and oedema, respectively). Forced expiratory volume in 1(st) second significantly increased in bisoprolol (1561±414ml to 1698±519ml, p = 0.046) but not carvedilol (1704±484 to 1734±548, p = 0.44) group. Both agents reduced heart rate (bisoprolol: 75±14 to 68±10, p = 0.007; carvedilol 78±14 to 72±12, p = 0.016) and had no effect on N-terminal pro brain natriuretic peptide.
CONCLUSIONS: Beta blockers frequently caused adverse events, and thus 49% of patients could tolerate the target dose. Bisoprolol induced demonstrable improvement in pulmonary function and caused less adverse events.

PMID: 22015086 [PubMed - in process]

The need for medication reconciliation: a cross-sectional observational study in adult patients.

Respir Med. 2011 Oct;105 Suppl 1:S60-6

Authors: Knez L, Suskovic S, Rezonja R, Laaksonen R, Mrhar A

Abstract
BACKGROUND: Poor communication of drug therapy at care interface often results in medication errors and adverse drug events. Medication reconciliation has been introduced as a measure to improve continuity of patient care. The aim of this cross-sectional observational study was to evaluate the need for medication reconciliation.
METHODS: Comprehensive information on pre-admission therapy was obtained by a research pharmacist for adult medical patients, admitted to a teaching hospital, specialised in pulmonary and allergic diseases, in Slovenia. This information was compared with the in-patient and discharge therapies to identify unintentional discrepancies (medication errors) whose clinical significance was determined by an expert panel reaching consensus.
RESULTS: Most of the included 101 patients were elderly (median age: 73 years) who had multiple medications. Among their in-patient drugs (880), few discrepancies were a medication error (54/654), half of which were judged to be clinically important. A higher rate was observed in the discharge drug therapy (747): 369 of the identified discrepancies (566) were a medication error, over half of which were judged as clinically important. A greater number of pre-admission drugs, poorly taken medication histories and a greater number of medication errors in in-patient therapy predisposed patients to clinically important medication errors in discharge therapy.
CONCLUSIONS: This study provided evidence in a small sample of patients on the discontinuity of drug therapy at patient discharge in a hospital in Slovenia and its implications for patient care. To ensure continuity and safety of patient care, medication reconciliation should be implemented throughout a patient's hospital stay.

PMID: 22015089 [PubMed - in process]

Alpha-1 antitrypsin is elevated in exhaled breath condensate and serum in exacerbated COPD patients.

Respir Med. 2011 Aug 25;

Authors: Rembert Koczulla A, Noeske S, Herr C, Koepke J, Jörres RA, Nell C, Schmid S, Vogelmeier C, Bals R

Abstract
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) significantly contribute to COPD-related morbidity. Diagnosis of COPD exacerbations may be improved by analyzing biomarkers such as alpha-1 antitrypsin (AAT). AAT is an acute-phase protein and inhibitor of neutrophil elastase. Deficiency of AAT may result in early-onset respiratory symptoms. Measurement of exhaled breath condensate (EBC) is a noninvasive method to investigate biomarkers present in the epithelial lining fluid, such as AAT. OBJECTIVE: To investigate whether AAT can be detected and quantified in EBC and to compare AAT levels in the EBC of healthy controls, patients with COPD, and during exacerbations of COPD. METHODS: EBC from 10 healthy controls, 17 subjects with COPD, and 18 subjects with exacerbations of COPD was collected with the RTube™ device. AAT from EBC and serum were quantified by ELISA. RESULTS: AAT in EBC was detectable in every individual. Patients with exacerbations of COPD had significantly increased AAT values (mean, 514.33pg/mL, [SD 279.41 ]) compared with healthy controls (mean, 251.32pg/mL, [SD 44.71]) and stable COPD patients (mean, 242.01pg/mL [SD 65.74]) (P=0.0003; P=0.00003). EBC AAT showed only a correlation trend with serum AAT (r=0.3, P=0.054). CONCLUSIONS: AAT in EBC was detectable and quantifiable. AAT measured in EBC was significantly increased during exacerbations of COPD and can potentially be used as a biomarker in exacerbations.

PMID: 21872457 [PubMed - as supplied by publisher]

Ischemia modified albumin in the differential diagnosis of pleural effusions.

Respir Med. 2011 Aug 13;

Authors: Dikensoy O, Celik N, Kul S, Gogebakan B, Bayram H, Light RW

The differential diagnosis of pleural effusion often requires invasive procedures. Up to 25 percent of pleural effusions can remain undiagnosed with an unclear pathogenesis. Therefore new biological markers may increase diagnostic yield and provide better understanding of pathogenesis of pleural effusion. We hypothesized that new ischemia biomarker, "ischemia modified albumin (IMA)" would help in both the differentiation of the underlying etiologies and provide a better understanding of pathogenesis of pleural effusions. This study was done between December 2009 and September 2010 in the Department of Pulmonary Diseases of Gaziantep University Hospital. One hundred and sixteen subjects with pleural effusion were included. Pleural and blood IMA levels were measured by ELISA. The underlying etiologies of pleural effusions were as follows: transudates (n = 50), malignancy (n = 32), tuberculosis (n = 12), pulmonary thromboembolism (n = 6), pneumonia (n = 16). The median pleural IMA levels were significantly different between the groups (p < 0.000). There were no such differences in the blood levels of IMA. The most striking difference in the median pleural IMA levels was between transudates and exudates (7986 (25-75%, 5145-56.505) ng/mL; 3376 (25-75%, 1935-4660) ng/mL; respectively, p = 0.000). The area under the ROC curve was 0.837 ± 0.038 for the cut-off level higher than 4711 ng l/mL for the differentiation of transudates from exudates (sensitivity, 82%; specificity, 78%; 95% CI, 0.76 to 0.91; p = 0.0000). In conclusion, the pleural IMA levels are higher in transudates compared to exudates. No such differences were observed in blood levels of IMA suggesting that there are reasons other than ischemia that cause an increase in pleural fluid IMA levels.

PMID: 21843931 [PubMed - as supplied by publisher]

Post-bronchoscopy sputum: Improving the diagnostic yield in smear negative pulmonary TB.

Respir Med. 2011 Aug 12;

Authors: George PM, Mehta M, Dhariwal J, Singanayagam A, Raphael CE, Salmasi M, Connell DW, Molyneaux P, Wickremasinghe M, Jepson A, Kon OM

INTRODUCTION: Patients with suspected active Pulmonary Tuberculosis (PTB) who are Acid-Fast Bacilli (AFB) smear negative or non-productive of sputum may undergo bronchoalveolar lavage. However, post-bronchoscopy sputum (PBS) sampling is not routine. The aim of this study was to establish the potential diagnostic value of PBS sampling. METHODS: A retrospective study of patients attending a London University hospital with microbiologically confirmed PTB between January 2004 and December 2010. Patients who were AFB smear negative or non-productive of sputum were eligible if sputum sampling was performed within 7 days of bronchoscopy. RESULTS: Over the study period, 236 patients had microbiologically confirmed smear negative PTB of which 57 patients were eligible for the study. 15 patients (26.3%) were infected with HIV. 19 patients (33.3%) converted to AFB sputum smear positivity post-bronchoscopy and 5 patients (8.8%) were exclusively AFB sputum smear positive on PBS microscopy. Mycobacterium tuberculosis was cultured from the PBS of 43 patients (75.4%) and of these, 4 (7.0%) were exclusively PBS culture positive. CONCLUSION: PBS analysis can provide a simple method of rapidly diagnosing pulmonary tuberculosis. In this cohort, M. tuberculosis culture yield was increased by 7% through PBS sampling. This study has important infection control implications with nearly one third of patients becoming more infectious after bronchoscopy.

PMID: 21840695 [PubMed - as supplied by publisher]