In clinic physiotherapy provides critical respiratory samples for infection diagnosis

Submitted by GAtherton on 3 February 2016

Physiotherapeutic interventions can safely and effectively obtain sputum from patients with Aspergillus-related diseases who are unable to spontaneously produce, a new study finds. 

A respiratory sample is critical for microbiological diagnosis of bacterial and fungal infections such as Pneumocystis pneumonia (PCP) and pulmonary aspergillosis. Many patients attending clinics report being unable to produce sputum spontaneously on request. 

A recent study conducted at the National Aspergillosis Centre, based at the University Hospital of South Manchester, found that the intervention of a physiotherapist helped 97% of patients who had previously reported being unable to spontaneously produce a sputum sample. The full study is published in BMC Pulmonary Medicine this month. Sputum from 59 patients (16%) yielded a strong Aspergillus PCR signal and in 124 (34%) patients other potentially pathogenic organisms grew which justified specific therapy.

65% of these patients needed only the intervention of Active Cycle of Breathing Techniques (ACBT) to produce sputum – a technique that takes the short treatment time of only 10 minutes, as demonstrated here. 

This non-pharmacological airway clearance method was extremely well tolerated by all patients, with no reported adverse effects or problems. 

ACBT is a set of breathing exercises performed in a cycle which loosens sputum from the lungs and moves it from the airways until the chest is cleared.¹

In this study, sputum was also obtained by nebulising salty water (hypertonic saline) induction in 119 (34%). Both methods are less invasive then other techniques such as bronchoscopy.²

Professor David Denning, Director of the National Aspergillosis Centre and the lead researcher on this study, says:

“An accurate microbiological diagnosis of chest infections enables optimum therapy but unfortunately patients attending clinics have normally already disposed of their morning sputum before arrival. This study shows that physiotherapy in clinic enables a significant number of patients to generate a quality diagnostic sample which helps improve detection of fungal disease.”