title: Diagnostic yield and safety of sputum induction with nebulized racemic salbutamol versus hypertonic saline in smear-negative pulmonary tuberculosis.
abstract: OBJECTIVE
  The aim of the study was to compare the diagnostic yield and safety profile of sputum induction (SI) with nebulized racemic salbutamol solution versus hypertonic saline in smear-negative pulmonary tuberculosis (TB).
  
  
  METHODS
  The prospective study was conducted at Songklanagarind Hospital, Thailand. Suspected smear-negative pulmonary TB cases were recruited and randomized to receive SI with either nebulized racemic salbutamol solution or 3% sodium chloride (NaCl) solution. Induced sputum was examined with the acid-fast bacilli (AFB) smear test and cultured for Mycobacterium tuberculosis. The efficacy and adverse events of SI were analyzed.
  
  
  RESULTS
  A total of 59 patients received SI with nebulized racemic salbutamol solution and 53 received 3% NaCl solution. There was no significant difference between the two groups in the average quantity of induced sputum (1.3 ± 0.1 versus 1.2 ± 0.2 ml, p = 0.5). The percentages of positive AFB smear and TB cultures in the salbutamol group were 15% and 22%, and 13% and 17% in the 3% NaCl group (p = 0.5), respectively. Racemic salbutamol solution could increase the TB diagnostic yield similarly to 3% NaCl, but incurred less chest tightness (5% versus 15%) and bronchospasm (0% versus 11.3%, p = 0.02) compared with 3% NaCl.
  
  
  CONCLUSIONS
  SI by nebulized racemic salbutamol solution offers equal benefits to 3% NaCl solution in increasing both sputum quantity and diagnostic yield in smear-negative patients suspected of having pulmonary TB. Nebulized racemic salbutamol does not produce bronchospasm and chest tightness occurs less frequently than with 3% NaCl. Therefore, SI with nebulized racemic salbutamol solution should be considered as a good alternative noninvasive diagnostic tool for the diagnosis of pulmonary TB when hypertonic saline is unavailable or contraindicated.
authors.affiliation: Assistant Professor, Division of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand tik25572014@hotmail.com.
authors.forename: Warangkana
authors.initials: W
authors.lastname: Keeratichananont
authors.affiliation: Department of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Thanapon
authors.initials: T
authors.lastname: Nilmoje
authors.affiliation: Department of Medicine, Bangkok Hospital Hat Yai, Songkhla,Thailand.
authors.forename: Suriya
authors.initials: S
authors.lastname: Keeratichananont
authors.affiliation: Department of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Jedsada
authors.initials: J
authors.lastname: Rittatorn
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D016037:Single-Blind Method; D013183:Sputum / Q000378:metabolism / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D012462:Saline Solution, Hypertonic; D000420:Albuterol
keywords: hypertonic saline; salbutamol nebulizer; smear-negative pulmonary tuberculosis; sputum induction