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Schultz A, Balaguruswamy S, Dentice R, Dobler CC, Geake J, Gibson P, Goulter P, Jayaram L, Laird PJ, Middleton PG, Seale H. Thoracic Society of Australia and New Zealand position statement: The safe clinical use of sputum induction for bio-sampling of the lower airways in children and adults. Respirology 2024; 29:372-378. [PMID: 38556839 DOI: 10.1111/resp.14707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
Sputum induction is widely used in clinical settings for collection of biological samples from the lower airways. However, in recent years sputum induction has been associated with serious adverse events and even death. This position statement was commissioned by the Thoracic Society of Australia and New Zealand to address major adverse events of two deaths associated with sputum induction that have occurred in Australia in 2021, and outlines best practice for the safe use of sputum induction. The statement resulted from systematic literature searches by a multi-disciplinary group including respiratory physicians, nurses and physiotherapists (paediatric and adults focused). Consumers had input to an advanced draft of the position statement. The position statement covers indications for sputum induction, informed consent, scope of practice of personnel administering the procedure, infection control considerations, details about the sputum induction procedure, safety considerations and risk assessment in clinical settings.
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Affiliation(s)
- André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Sathya Balaguruswamy
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ruth Dentice
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Claudia C Dobler
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - James Geake
- Department of Thoracic and Sleep Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Patricia Goulter
- Physiotherapy Department, Te Whatu Ora (Health New Zealand), Wellington, New Zealand
| | - Lata Jayaram
- Department of Respiratory and Sleep Medicine, Western Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Pamela J Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Peter G Middleton
- Westmead Clinical School, University of Sydney, Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Helen Seale
- Department of Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Chang AB, Bell SC, Byrnes CA, Dawkins P, Holland AE, Kennedy E, King PT, Laird P, Mooney S, Morgan L, Parsons M, Poot B, Toombs M, Torzillo PJ, Grimwood K. Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand. Respirology 2023; 28:339-349. [PMID: 36863703 PMCID: PMC10947421 DOI: 10.1111/resp.14479] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023]
Abstract
This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi-disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co-existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed-tomography scan, using age-appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop individualized management plans that include a multi-disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality-of-life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14-day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. Individualize therapy for long-term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6-monthly monitoring for complications and co-morbidities. Undertake optimal care of under-served peoples, and despite its challenges, delivering best-practice treatment remains the overriding aim.
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Affiliation(s)
- Anne B. Chang
- Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Scott C. Bell
- Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- Translational Research InstituteBrisbaneQueenslandAustralia
| | - Catherine A. Byrnes
- Department of PaediatricsUniversity of AucklandAucklandNew Zealand
- Starship Children's HospitalAucklandNew Zealand
| | - Paul Dawkins
- Department of Respiratory MedicineMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
| | - Anne E. Holland
- Department of PhysiotherapyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Institute for Breathing and SleepHeidelbergVictoriaAustralia
| | - Emma Kennedy
- College of Medicine and Public HealthFlinders UniversityDarwinNorthern TerritoryAustralia
- Board of Northern Territory General Practice Education LtdDarwinNorthern TerritoryAustralia
- Pandanus Medical NTMillnerNorthern TerritoryAustralia
| | - Paul T. King
- Departments of Respiratory and Sleep Medicine and Medicine, Monash Medical CentreMonash UniversityMelbourneVictoriaAustralia
| | - Pamela Laird
- Department PhysiotherapyPerth Children's HospitalPerthWestern AustraliaAustralia
- Wal‐yan Respiratory Research CentreTelethon Kids InstitutePerthWestern AustraliaAustralia
- Department of Paediatrics, School of MedicineUniversity of WAPerthWestern AustraliaAustralia
| | - Sarah Mooney
- Department of Respiratory MedicineMiddlemore HospitalAucklandNew Zealand
- School of Clinical SciencesAUT UniversityAucklandNew Zealand
| | - Lucy Morgan
- Department of Respiratory Medicine at Concord and Nepean HospitalsSchool of Medicine, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Marianne Parsons
- Representative of Parent Advisory Group, NHMRC Centre of Research Excellence in Paediatric Bronchiectasis, Cough and Airways Research Group, Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Betty Poot
- Respiratory DepartmentHutt Hospital, Te Whatu Ora Capital, Coast and Hutt ValleyLower HuttNew Zealand
- School of Nursing Midwifery, and Health PracticeVictoria University of WellingtonWellingtonNew Zealand
| | - Maree Toombs
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Paul J. Torzillo
- Nganampa Health CouncilAlice SpringsNorthwest TerritoriesAustralia
- Royal Prince Alfred HospitalUniversity of SydneySydneyNew South WalesAustralia
| | - Keith Grimwood
- School of Medicine and Dentistry, Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
- Departments of Infectious Diseases and PaediatricsGold Coast HealthSouthportQueenslandAustralia
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