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Physiotherapy in clinic provides critical respiratory samples for fungal infection diagnosis

February 03 2016

A  respiratory sample is critical for microbiological diagnosis of bacterial and fungal infections such as Pneumocystis pneumonia (PCP) and pulmonary aspergillosis, but many patients are unable to produce sputum samples on request. A recent study conducted at the National Aspergillosis Centre, based at the University Hospital of South Manchester, UK found that the intervention of a physiotherapist helped 97% of patients who had previously reported being unable to spontaneously produce a sputum sample.

Sputum was procured in 353 out of 364 patients, 65% of patients used ACBT and 34% used by nebulising salty water.

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

Samples were divided and analysed by microscopy, culture and PCR.

 This non-pharmacological airway clearance method was extremely well tolerated by all patients, with no reported adverse effects or problems. Both methods  for obtaining sputum samples are less invasive then other techniques such as bronchoscopy.

Colonisation of the airway is more common in COPD & cystic fibrosis but identifiying Aspergillus species requires more urgent management. Comparing the methodology for Aspergillus detection - fungal cultures were positive in 16 patients, whereas PCR was positive in 72 patients - an enhanced yield of 360%, with a strong signal in 59, so molecular detection of Aspergillus spp was far superior than culture.

The sputum from 34% of the patients grew other potentially harmful pathogens which also justified the specific therapy.

This study shows that physiotherapy in the  clinic enables a significant number of patients to generate a quality diagnostic sample which helps improve detection of fungal disease.

Article

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