Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents

Egberto Luiz Felicio-Júnior, Viviani Barnabé, Francine Maria de Almeida, Monise Dematte Avona, Isabella Santos de Genaro, Adriana Kurdejak, Miriam Cardoso Neves Eller, Karina Pierantozzi Verganid, Joaquim Carlos Rodrigues, Iolanda de Fátima Lopes Calvo Tibério, Milton de Arruda Martins, Beatriz Mangueira Saraiva-Romanholo, Egberto Luiz Felicio-Júnior, Viviani Barnabé, Francine Maria de Almeida, Monise Dematte Avona, Isabella Santos de Genaro, Adriana Kurdejak, Miriam Cardoso Neves Eller, Karina Pierantozzi Verganid, Joaquim Carlos Rodrigues, Iolanda de Fátima Lopes Calvo Tibério, Milton de Arruda Martins, Beatriz Mangueira Saraiva-Romanholo

Abstract

Objectives: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents.

Methods: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042.

Results: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients.

Conclusion: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1. Study design. Cross-over techniques of…
Figure 1. Study design. Cross-over techniques of induced sputum collection. HS: hypertonic saline; P: physiotherapy; HSP: hypertonic saline + physiotherapy.
Figure 2. Illustrative image showing a patient…
Figure 2. Illustrative image showing a patient performing oscillating positive expiratory pressure therapy for 5 min in a sitting position.
Figure 3. Illustrative image demonstrating the forced…
Figure 3. Illustrative image demonstrating the forced expiration (huffing) technique associated with accelerated expiratory flow. The therapist places one hand on the patient’s manubrium and the other hand on the xiphoid process of the patient’s sternum. Thereafter, the therapist brings the two hands together during the patient’s exhalation, accelerating the outflow of air, while the patient simultaneously exhales with the glottis and mouth open, and the abdominal muscles contracted.

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