Abstract
Lung damage in Cystic Fibrosis (CF) is strongly associated with lower airway infections. Early treatment of Pseudomonas aeruginosa is recommended. Pathogen detection requires sampling of lower airway secretions, which remains a challenge in non-expectorating patients. Our hypothesis was that chest physiotherapy would improve the quality of airway secretion samples and increase the rates of pathogens detected in non-expectorating patients.
This prospective multicentre study compared three successive methods for sampling airway secretions applied through a same session: 1) oropharyngeal swab (OP); 2) sputum collected after chest physiotherapy (CP-SP); and 3) oropharyngeal swab 2 performed after chest physiotherapy(CP-SP-CP-OP). Haemophilus influenzae, Staphylococcus aureus and P. aeruginosa (Pa) growth cultures were assessed. Accuracy tests and an equivalence test was performed to compare the three successive methods of collection. Three-hundred non-expectorating children with CF were included. Pa was detected cumulatively in 56 (18.9%) children and according to the collection techniques in 28 (9.8%), 37(12.4%) and 44 (15%) children by using CP-SP and CP-OP, respectively. Compared to OP, the increased detection rate was +22% for CP-OP, p=0029 and +57% for CP-SP, p=0.003. CP-SP had the best positive predictive value (PPV) (86.3%) and negative PV (96%) for Pa compared to the overall detection. The results of this adequately powered study show differences in the rates of pathogens detected according to the sampling method used. Chest physiotherapy enhanced detection of P. aeruginosa in non-expectorating children with CF.
Footnotes
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Conflict of interest: Dr. MARGUET has nothing to disclose.
Conflict of interest: Dr. Houdouin has nothing to disclose.
Conflict of interest: I. Pin reports a presentation honorarium and travel grants from Novartis, and travel grants from AstraZeneca and AGIRadom, outside the submitted work.
Conflict of interest: Dr. REIX has nothing to disclose.
Conflict of interest: Dr. HUET has nothing to disclose.
Conflict of interest: Dr. MITTAINE has nothing to disclose.
Conflict of interest: Dr. RAMEL has nothing to disclose.
Conflict of interest: Dr. WIZLA-DERAMBURE has nothing to disclose.
Conflict of interest: Dr. ABELY has nothing to disclose.
Conflict of interest: Dr. Dalphin has nothing to disclose.
Conflict of interest: Dr. FAYON has nothing to disclose.
Conflict of interest: T. Bihouée reports fees for a commercial article from Vertex, personal fees for speaker bureaus from Novartis and Mylan, and travel support and regisitration for a congress from Teva, outside the submitted work.
Conflict of interest: Dr. LE BOURGEOIS has nothing to disclose.
Conflict of interest: Dr. DENEUVILLE has nothing to disclose.
Conflict of interest: Dr. CORVOL has nothing to disclose.
Conflict of interest: Dr. Laurens has nothing to disclose.
Conflict of interest: Dr. Couderc has nothing to disclose.
Conflict of interest: Evelyne Leroux
Conflict of interest: Dr. Lemée has nothing to disclose.
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- Received October 2, 2020.
- Accepted December 5, 2020.
- Copyright ©ERS 2021
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
