Selection of cases with high sputum bacillary loads complicates extrapolation of results to patients with paucibacillary or extrapulmonary disease.
Samples were collected at onset and fifth month of treatment from patients registered with the DOTS (Directly Observed Therapy Short Course) Centers of the RNTCP Revised National Tuberculosis Control Programmee) in 4 centrally located wards, characterized by a high sputum positive case load and covering a population of 3 million.
We observed significantly higher sputum virus loads in subjects with COPD, confirming for the first time, to our knowledge, impaired antiviral immunity in COPD results in more severe lower respiratory virus infection.
Indeed, only 18% of subjects had neither high sputum eosinophils nor high red hue.
There were no differences in baseline lung function, health status or exacerbation frequency between the groups: A-low red hue, high sputum eosinophils (n = 10), B-high red hue, high sputum eosinophils (n = 16), C-low red hue, low sputum eosinophils (n = 19) and D- high red hue, low sputum eosinophils (n = 58).
The upper limit of the normal range for sputum eosinophils was set at 3% as derived from a group of normal participants, whereas high sputum neutrophils were defined when the sputum neutrophil percentage was >63%.
The 103 COPD subjects were categorised into four groups: A-low red hue, high area under the curve sputum eosinophil count (n = 10), B-high red hue, high sputum eosinophils (n = 16), C-low red hue, low sputum eosinophil (n = 19), and D-high red hue, low sputum eosinophils (n = 58).
All of the patients had evidence of chronic productive cough and some experienced high sputum volumes.
Our results showed a very high level of agreement on the importance of knowing sputum load for decisions to extubate, decanulate or discharge from the ITU.
In contrast, there was little consensus on how we should quantify sputum load in ventilated patients.
