SI was relatively well tolerated by all subjects, However, two subjects had a > 15% fall in FEVj with this procedure even when premedicated with albuterol, However, the adverse effects associated with the sedation and the procedure of bronchoscopy with BAL on pulmonary function and oxygenation in patients with CF is not well reported but would appear greater than those of SI. Throat irritation was felt by three subjects.
Induction of sputum with 3% hypertonic saline solution has been shown to be relatively safe in patients with moderate-to-severe asthma,’’ and was associated with no serious adverse events in our 10 subjects with CF. The majority of CF patients have reactive airway disease, but the degree of airway reactivity to the challenge of hypertonic saline solution in the limited number of CF subjects studied to date appears to be less than that observed among asthmatic subjects. canadianfamilypharmacy
Only 1 of our 10 subjects was not able to produce 1 mL of sample volume at each time point, the minimum volume often necessary to perform routine assays and reproducible cell counts. In the induced-sputum protocol of asthmatic subjects that we adopted, the methodologies call for a collection time of 12 min,’’ although a 1-mL sample after a minimum time period of 4 min is deemed acceptable. In asthmatic subjects, fractional analysis of sequential induced sputum at 4-min intervals over a 20-min interval showed a decrease in percentage of PMNs and an increase in percentage of macrophages after the 0- to 4-min aliquot. In the CF population, the total cell counts are higher than those seen in asthmatics, reflecting the chronic infected airways of CF patients. The change in aliquots appeared to be less pronounced than those of asthmatics, so that a 4-min collection may be more representative of a longer time sample in CF subjects. Thus, shorter sputum collection times may be adequate for CF subjects.