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In most settings, sputum is not routinely collected for microbiological diagnosis from children with lower respiratory disease. To evaluate whether it is feasible and diagnostically useful to collect sputum in the Pneumonia Etiology Research for Child Health (PERCH) study, we reviewed the literature on induced sputum procedures. Protocols for induced sputum in children were collated from published reports and experts on respiratory disease and reviewed by an external advisory group for recommendation in the PERCH study. The advisory group compared 6 protocols: 4 followed a nebulization technique using hypertonic saline, and 2 followed a chest or abdomen massage technique. Grading systems for specimen quality were evaluated. Collecting sputum from children with lower respiratory tract illness is feasible and is performed around the world. An external advisory group recommended that sputum be collected from children hospitalized with severe and very severe pneumonia who participate in the PERCH study provided no contraindications exist. PERCH selected the nebulization technique using hypertonic saline.

Original publication




Journal article


Clin Infect Dis

Publication Date



54 Suppl 2


S140 - S145


Administration, Inhalation, Child, Humans, Infant, Nebulizers and Vaporizers, Pneumonia, Quality Control, Respiratory Function Tests, Respiratory Tract Diseases, Saline Solution, Hypertonic, Severity of Illness Index, Specimen Handling, Sputum