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1.
Pamela Hepple Pascal Nguele Jane Greig Maryline Bonnet Vinciane Sizaire 《BMC infectious diseases》2010,10(1):276
Background
Diagnostic options for pulmonary tuberculosis in resource-poor settings are commonly limited to smear microscopy. We investigated whether bleach concentration by sedimentation and sputum cytology analysis (SCA) increased the positivity rate of smear microscopy for smear-positive tuberculosis. 相似文献2.
Heidi Albert Patrick J Ademun George Lukyamuzi Barnabas Nyesiga Yukari Manabe Moses Joloba Stuart Wilson Mark D Perkins 《BMC infectious diseases》2011,11(1):125
Background
Direct sputum smear microscopy is the mainstay of TB diagnosis in most low and middle income countries, and is highly specific for Mycobacterium tuberculosis in such settings. However it is limited by low sensitivity, particularly in HIV co-infected patients. Concentration by centrifugation has been reported to be more sensitive than direct smear preparation, but is only suitable for referral laboratories. Simpler concentration methods that could be applied in peripheral laboratories are urgently needed. 相似文献3.
George PM Mehta M Dhariwal J Singanayagam A Raphael CE Salmasi M Connell DW Molyneaux P Wickremasinghe M Jepson A Kon OM 《Respiratory medicine》2011,105(11):1726-1731
Introduction
Patients with suspected active Pulmonary Tuberculosis (PTB) who are Acid-Fast Bacilli (AFB) smear negative or non-productive of sputum may undergo bronchoalveolar lavage. However, post-bronchoscopy sputum (PBS) sampling is not routine. The aim of this study was to establish the potential diagnostic value of PBS sampling.Methods
A retrospective study of patients attending a London University hospital with microbiologically confirmed PTB between January 2004 and December 2010. Patients who were AFB smear negative or non-productive of sputum were eligible if sputum sampling was performed within 7 days of bronchoscopy.Results
Over the study period, 236 patients had microbiologically confirmed smear negative PTB of which 57 patients were eligible for the study. 15 patients (26.3%) were infected with HIV. 19 patients (33.3%) converted to AFB sputum smear positivity post-bronchoscopy and 5 patients (8.8%) were exclusively AFB sputum smear positive on PBS microscopy. Mycobacterium tuberculosis was cultured from the PBS of 43 patients (75.4%) and of these, 4 (7.0%) were exclusively PBS culture positive.Conclusion
PBS analysis can provide a simple method of rapidly diagnosing pulmonary tuberculosis. In this cohort, M. tuberculosis culture yield was increased by 7% through PBS sampling. This study has important infection control implications with nearly one third of patients becoming more infectious after bronchoscopy. 相似文献4.
《Respirology (Carlton, Vic.)》2018,23(10):950-955
Background and objective
Delayed diagnosis and treatment of tuberculosis (TB) contribute to poor outcomes, especially for endobronchial TB (EBTB), which typically leads to tracheobronchial stenosis. Finding rapid and accurate diagnostic tools for EBTB is crucial. GeneXpert Mycobacterium tuberculosis (MTB)/rifampin (RIF) was recommended by the World Health Organization (WHO) as a standard molecular biological diagnostic technique for MTB. The aim of this study was to evaluate the efficacy of GeneXpert MTB/RIF for diagnosing EBTB and for evaluating RIF resistance.Methods
Biopsy tissue and bronchial brushings from EBTB patients were prospectively assessed with GeneXpert MTB/RIF. The diagnostic yields of auramine O‐stained sputum smears and bronchial brush smears were obtained, and the results were compared with the cultures of sputum and biopsy tissues for MTB.Results
In 61 confirmed cases of EBTB, the sensitivities of sputum smear, bronchial brush smear, sputum culture and tissue culture to diagnose EBTB were 13.1%, 32.8%, 36.1% and 68.9%, respectively. For bronchial brushings and biopsies, our data showed sensitivities of 57.4% and 63.9%, respectively, and a specificity of 100% for GeneXpert MTB/RIF, and these results were superior to those of sputum smears, bronchial brush smears and sputum culture. GeneXpert MTB/RIF for bronchial brushings and biopsies showed complementarity in its diagnostic performance. Resistance to RIF was identified in 17.4% (8/46) of GeneXpert MTB‐positive cases.Conclusion
GeneXpert MTB/RIF may enable more rapid EBTB diagnosis and determination of RIF resistance, which are crucial for timely treatment.5.
A Wilmer E Bryce J Grant 《The Canadian Journal of Infectious Diseases & Medical Microbiology》2011,22(1):e1-e3
INTRODUCTION:
Recent studies have suggested that two negative acid-fast bacillus (AFB) smears may be as effective as three when screening patients with suspected Mycobacterium tuberculosis for respiratory isolation purposes. However, current recommendations in Canada, the United States and Europe still support a three-smear approach.METHODS:
The microbiology database of a tertiary care hospital was searched for sputum, tracheal aspirates and bronchoalveolar lavage samples from 2003 to 2007 that had been sent for mycobacterial testing. The first patient specimen to become AFB smear positive was noted. As well, the time required to collect the third specimen in hospitalized patients who remained smear negative was used to estimate the savings in isolation costs associated with a two-smear approach.RESULTS:
There were 8347 respiratory specimens from 5168 patients in the five-year period. Of these patients, 2.2% (116 of 5168) were AFB smear positive, of whom 55.2% (64 of 116) were culture positive for Mycobacterium tuberculosis. Overall 89% (57 of 64) of patients were identified as being AFB smear positive by the first smear, 7.8% (five of 64) were identified by the second smear and 3.2% (two of 64) were identified by further smears. Smear-negative patients spent a combined 710 days in isolation awaiting collection of the third sample at a cost of approximately $142,000 over five years.CONCLUSION:
A two-smear approach for discontinuation of respiratory isolation precautions is safe and has the potential to reduce hospital expenditures. 相似文献6.
Adithya Cattamanchi David W Dowdy J Lucian Davis William Worodria Samuel Yoo Moses Joloba John Matovu Philip C Hopewell Laurence Huang 《BMC infectious diseases》2009,9(1):53
Background
Sputum concentration increases the sensitivity of smear microscopy for the diagnosis of tuberculosis (TB), but few studies have investigated this method in human immunodeficiency virus (HIV)-infected individuals. 相似文献7.
Background
The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by CXR) with an alternative pathway using CXR as a screening tool (CXR followed by ZN). 相似文献8.
Daily adjunctive therapy with vitamin D3 and phenylbutyrate supports clinical recovery from pulmonary tuberculosis: a randomized controlled trial in Ethiopia
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S. Ashenafi E. Kassa G. Aseffa W. Amogne M. Getachew A. Aseffa A. Worku R. Raqib B. Agerberth U. Hammar P. Bergman G. Aderaye J. Andersson S. Brighenti 《Journal of internal medicine》2018,284(3):292-306
Objective
Immunotherapy using vitamin D (vitD3) and phenylbutyrate (PBA ) may support standard drug regimens used to treat infectious diseases. We investigated if vitD3 + PBA enhanced clinical recovery from pulmonary tuberculosis (TB ).Methods
A randomized controlled trial was conducted in Addis Ababa, Ethiopia. Patients with smear‐positive or smear‐negative TB received daily oral supplementation with 5000 IU vitD3 and 2 × 500 mg PBA or placebo for 16 weeks, together with 6‐month chemotherapy. Primary end‐point: reduction of a clinical composite TB score at week 8 compared with baseline using modified intention‐to‐treat (mITT , n = 348) and per‐protocol (n = 296) analyses. Secondary end‐points: primary and modified TB scores (week 0, 4, 8, 16, 24), sputum conversion, radiological findings and plasma 25(OH )D3 concentrations.Results
Most subjects had low baseline plasma 25(OH )D3 levels that increased gradually in the vitD3 + PBA group compared with placebo (P < 0.0001) from week 0 to 16 (mean 34.7 vs. 127.4 nmol L?1). In the adjusted mITT analysis, the primary TB score was significantly reduced in the intervention group at week 8 (?0.52, 95% CI ?0.93, ?0.10; P = 0.015) while the modified TB score was reduced at week 8 (?0.58, 95% CI ?1.02, ?0.14; P = 0.01) and 16 (?0.34, 95% CI ?0.64, ?0.03; P = 0.03). VitD3 + PBA had no effect on longitudinal sputum‐smear conversion (P = 0.98). Clinical adverse events were more common in the placebo group (24.3%) compared with the vitD3 + PBA group (12.6%).Conclusion
Daily supplementation with vitD3 + PBA may ameliorate clinical TB symptoms and disease‐specific complications, while the intervention had no effect on bacterial clearance in sputum.9.
BACKGROUND:
Diagnosing pulmonary tuberculosis (PTB) is challenging in patients who are unable to spontaneously expectorate. Published evidence suggests that induced sputum (IS) is the least invasive and most cost-effective method of diagnosis, and should be used before fibre-optic bronchoscopy (FOB).METHODS:
The medical records of 337 adults treated for PTB in northern Alberta between 1997 and 2007 were reviewed to determine whether local practice patterns reflect the evidence. Microbiological data were collected from the Provincial Laboratory for Public Health. Demographic information was collected from the patients’ charts.RESULTS:
A total of 8.5% (26 of 307) of PTB patients had IS collected, whereas 35.8% (110 of 307) underwent FOB. Among FOB patients, 56.4% (62 of 110) had no sputum sent before the procedure and 29% (18 of 62) of these patients were smear positive. Only five patients referred for FOB had IS sent previously. There were no demographic factors predictive of IS use, whereas being an inpatient at a teaching facility or having a nodule or mass on chest x-ray was predictive of FOB referral. Because so few IS samples were available, not all patients had spontaneously expectorated sputum, IS and FOB tests performed; thus, the calculated yields were not comparable with one another.CONCLUSIONS:
Despite published evidence recommending IS collection before FOB referral in suspected PTB patients, clinicians in our health region appeared to prefer early FOB over IS by a large margin. This practice pattern is less cost effective and exposes patients and health care workers to greater risk. Further research is needed to identify the reasons for the underuse of sputum induction. 相似文献10.
Rohit Sarin Vikram Vohra U.K. Khalid Prem Prakash Sharma Vineet Chadha M.A. Sharada 《The Indian journal of tuberculosis》2018,65(2):130-134
Background
A survey was carried out to estimate the point prevalence of bacteriologically positive pulmonary tuberculosis (PTB) among persons ≥15 years of age residing in Jhuggi–Jhopri (JJ) colonies – urban slums in Delhi, India implementing Directly Observed Treatment strategy since 1998.Methods
Among 12 JJ colonies selected by simple random sampling, persons having persistent cough for ≥2 weeks at the time of the survey or cough of any duration along with history of contact/currently on ant-TB treatment/known HIV positive were subjected to sputum examination – 2 specimens, by smear microscopy for Acid Fast Bacilli and culture for Mycobacterium tuberculosis. Persons with at least one specimen positive were labelled as bacteriologically confirmed PTB. Prevalence was estimated after imputing missing values to correct bias introduced by incompleteness of data and corrected for non-screening by X-ray by a multiplication factor derived from recently conducted surveys.Results
Of 40,756 persons registered, 40,529 (99.4%) were screened. Of them, 691 (2%) were eligible for sputum examination. Spot specimens were collected from 659 (99.2%) and early morning sputum specimens from 647 (98.1%).Using screening by interview alone, prevalence of bacteriologically positive PTB in persons ≥15 years of age was estimated at 160.4 (123.7–197.1) per 100,000 populations and210.0 (CI: 162.5–258.2) after correcting for non-screening by X-ray.Conclusion
Observed prevalence suggests further strengthening of TB control program in urban slums. 相似文献11.
Sanja Percac-Lima Leslie S. Aldrich Gloria B. Gamba Adriana M. Bearse Steven J. Atlas 《Journal of general internal medicine》2010,25(11):1198-1204
BACKGROUND
Lower rates of follow-up after an abnormal Pap smear in racial and ethnic minorities may contribute to the higher incidence and mortality rates of cervical cancer seen in these groups. 相似文献12.
Varinder Saini Bhaskar Lokhande Shivani Jaswal Deepak Aggarwal Kranti Garg Jasbinder Kaur 《The Indian journal of tuberculosis》2018,65(1):30-34
Background
Definitive laboratory diagnosis and confirmation of tuberculosis remains a major challenge because of lack of specificity and sensitivity of diagnostic methods especially in sputum smear negative tuberculosis. Many studies have proved the role of ADA in diagnosis of tuberculosis in effusion fluids and a decrease in ADA activity after treatment. This study was aimed to investigate the role of serum ADA level as an early diagnostic and prognostic marker for pulmonary tuberculosis (PTB).Material and methods
This was a cohort study done on patients visiting the OPD Clinics of the department of Pulmonary Medicine at GMCH, Chandigarh. 50 sputum positive and 50 sputum negative tuberculosis patients and 100 controls were recruited. Serum ADA levels were measured at the start of treatment and again after two months of treatment. Its correlation with severity of disease was seen.Results
Mean serum ADA (IU/L) was found to be 35.293 ± 30.941 in PTB patients and 11.819 ± 8.023 in control groups and the difference was found to be highly significant (P < 0.00). Mean ADA was 31.107 ± 29.32 in sputum positive patients, 39.478 ± 32.22 in sputum negative and 11.819 ± 8.0235 in control groups. No statistically significant difference was observed amongst sputum positive and sputum negative patients. The levels decreased significantly after intensive phase of treatment. At the cut off values of 14.6 IU/L, serum ADA had 78% sensitivity and 76% specificity (AUC = 0.801, P value < 0.00) to differentiate between PTB from healthy controls.Conclusion
Serum ADA levels may be used as a biomarker for diagnosis of PTB and to evaluate the response to treatment at follow up. 相似文献13.
Shu-Hua Yang Ping Zhan Hui-Huan Mao Xu-Dong Shi Ling-Ling Wang 《Journal of thoracic disease》2013,5(4):466-471
Background
Pulmonary tuberculoma is a special form of secondary pulmonary tuberculosis, with a poor response to drug treatment. We used the method of drug administration via percutaneous lung puncture “holing” to treat pulmonary tuberculoma and observe its short- and long-term efficacy, summing up our 10-year clinical experience.Methods
A total of 54 patients with pulmonary tuberculoma were included in this study. They themselves were taken as the control group. Three to six months of conventional anti-tuberculosis treatment was conducted firstly. Then those patients with no changes of sizes in tuberculoma were recommended to receive drug administration via percutaneous lung puncture. Isoniazid (INH, 0.1 g) and amikacin (AMK, 0.2 g) were injected into tuberculoma (once or twice per week, 10 times as a course of treatment).Results
After two months of drug treatment by lung puncture, the sputum smear test showed the negative conversion rate of tubercle bacillus was 87% (13/15), and the positive conversion rate was 8% (3/39). The tuberculosis bacillus culture indicated that the negative conversion rate was 100% (7/7). The reexamination after one year showed the negative conversion rate of tubercle bacillus in the sputum smear test was 80% (4/5). About 58% (31/54) of tuberculoma disappeared or significantly reduced, in which, 40% (21/54) of tuberculoma disappeared. The tuberculoma diameter reduced from 3.6 cm × 2.8 cm to 1.7 cm × 1.1 cm on average. Side-effects included postoperative pneumothorax 9% (5/54), hemoptysis 7% (4/54) and fever 11% (6/54). A total of 34 patients were followed up for five years, and the disappearance rate of tuberculoma was up to 47% (16/34), with no recurrence.Conclusions
The drug administration via percutaneous lung puncture—“holing” in pulmonary tuberculoma takes a significant effect obviously, good short- and long-term effects and less side effects.KEY WORDS : Percutaneous lung puncture, pulmonary tuberculoma, holing 相似文献14.
Warren JR Bhattacharya M De Almeida KN Trakas K Peterson LR 《American journal of respiratory and critical care medicine》2000,161(5):1559-1562
Detection of acid-fast bacilli (AFB) by sputum smear supports treatment decisions with pulmonary tuberculosis (TB), but smear sensitivity for Mycobacterium tuberculosis is only approximately 45 to 75%. In an effort to increase sensitivity, smears were prepared using a minimum sputum volume of 5.0 ml. Sensitivity of smears during a 39-mo period (n = 1,849) using >/= 5.0 ml of sputum was 92. 0%, significantly greater (p < 0.001) than a sensitivity of 72.5% in a previous 24-mo period (n = 3,486) when all specimens were processed regardless of volume. All new cases of TB (n = 18) were smear-positive with >/= 5.0 ml of sputum before treatment, and all were receiving antituberculosis drugs at hospital discharge. In contrast, significantly fewer new cases of TB (14 of 26, p = 0.002) were positive before treatment when smears were prepared using sputum of any volume, and significantly fewer of these new TB cases (18 of 26, p = 0.03) were receiving treatment at hospital discharge. The eight cases without treatment were smear-negative. These results indicate that acid-fast smear using >/= 5.0 ml of sputum increases sensitivity for M. tuberculosis and accelerates treatment of TB. 相似文献
15.
Heidi Albert Freddie Bwanga Sheena Mukkada Barnabas Nyesiga Julius Patrick Ademun George Lukyamuzi Melles Haile Sven Hoffner Moses Joloba Richard O'Brien 《BMC infectious diseases》2010,10(1):41
Background
About 500 new smear-positive Multidrug-resistant tuberculosis (MDR-TB) cases are estimated to occur per year in Uganda. In 2008 in Kampala, MDR-TB prevalence was reported as 1.0% and 12.3% in new and previously treated TB cases respectively. Line probe assays (LPAs) have been recently approved for use in low income settings and can be used to screen smear-positive sputum specimens for resistance to rifampicin and isoniazid in 1-2 days. 相似文献16.
Ranjeet Kumar Jaswant Rai N.C. Kajal Pushpa Devi 《The Indian journal of tuberculosis》2018,65(3):246-251
Background
Ashwagandha (Withania somnifera Linn.) a rejuvenative herb has long been used as an immunomodulator in Indian subcontinent. As immunity plays an important role in pathogenesis and treatment of tuberculosis (TB), so role of W. somnifera as an adjuvant has been studied on selected parameter.Method
A randomized, double-blind placebo-control study was conducted in two groups of 60 newly diagnosed sputum smear positive pulmonary TB patients on Directly Observed Treatment – short course (DOTS) regime. W. somnifera root extract or placebo capsules were given as add-on therapy for duration of 12 weeks. Effects on sputum conversion, Hemoglobin (Hb), body weight, Erythrocyte Sedimentation Rate (ESR), RBC counts, WBC counts, CD4 and CD8 counts, Serum Glutamic-Oxaloacetic Transaminase (SGOT), Serum Glutamic-Pyruvic Transaminase (SGPT), serum uric acid and HRQL (Health Related Quality of Life) Index scores were studied.Results
At the end of 8 weeks, sputum conversion was seen in 86.6% patients in study group and 76.6% in placebo group. At the end of 12 weeks a highly significant increase was seen in both CD4 and CD8 counts in study group. A raised SGOT and SGPT levels (>35 IU/L) were observed in 16.6% and 33.3% patients in study group; 43.33% and 53.33% in the placebo group of patients. Elevated serum uric acid levels (>6 mg/dl) were observed in 20% and 33.33% in study and placebo group respectively. Average gain in HRQL score was better in patients of study group.Conclusion
Use of W. somnifera as an adjuvant in conjunction with anti-TB drugs used as DOTS showed a favorable effect on symptoms and immunological parameters in patients with pulmonary TB. 相似文献17.
Wendy A Kennedy Frédéric Girard Simone Chaboillez André Cartier Johanne C?té Frederick Hargreave Manon Labrecque Jean-Luc Malo Susan M Tarlo Carrie A Redlich Catherine Lemière 《Canadian respiratory journal》2007,14(5):276-280
BACKGROUND:
Diagnosis of occupational asthma (OA) by specific inhalation challenge (SIC) can be costly and is not always available. The use of sputum testing to avoid this in some patients may be a more cost-effective alternative.OBJECTIVES:
To compare the cost-effectiveness of SIC with serial measurements of sputum cell counts (sputum testing) and peak expiratory flow (PEF) monitoring.METHODS:
Clinical data and testing costs for OA in 49 patients were collected during a previously published trial, modelled and compared using TreeAge Pro. Clinical outcome was the percentage of accurately diagnosed patients, using SIC as the gold standard. The PEF approach used the most accurate assessment of five experts who were blinded to SIC results. Differences in the proportion of eosinophils during periods on and off work were used for the sputum testing approach and in PEF/sputum for the combined approach. Unit costs were estimated from charges in Canadian hospitals. Data were analyzed by one-way and two-way analyses, and by probabilistic sensitivity analysis using a Monte Carlo simulation technique.RESULTS:
The PEF approach had an estimated accuracy of 52% and cost $365 per patient tested. Compared with PEF monitoring, sputum testing was more accurate and cost an estimated $255 for each additional OA patient correctly diagnosed. SIC costs per additional correct diagnosis were $11,032 compared with sputum testing and $6,458 compared with PEF monitoring. The combined PEF/sputum testing approach was not cost-effective in the base case analysis, but cannot be excluded according to probabilistic sensitivity analyses.CONCLUSIONS:
Although SIC remains the reference test to diagnose OA, when this test is not available, sputum testing is a cost-effective alternative to PEF for diagnosis of OA. 相似文献18.
Liesel D��silva Christopher J Allen Frederick E Hargreave Krishnan Parameswaran 《Canadian respiratory journal》2007,14(5):281-284
BACKGROUND:
Exacerbations of airway disease are eosinophilic, neutrophilic, both or neither. The primary objective of the present study was to identify whether the treatment of a neutrophilic bronchitis can unmask an associated eosinophilia.METHODS:
A retrospective survey of 2160 consecutive sputum cell counts from 1343 patients with airway disease was conducted to identify patients with an isolated neutrophilic bronchitis, which was defined as a sputum total cell count of greater than or equal to 12×106 cells/g of sputum and a proportion of neutrophils of 80% or greater. The characteristics of the patients who subsequently demonstrated sputum eosinophilia (3% or greater) within eight weeks of resolving the neutrophilia were compared with the patients who subsequently did not have sputum eosinophilia.RESULTS:
Two hundred thirty-seven patients had 273 neutrophilic exacerbations. The sputum was re-examined within eight weeks in 65 patients (27.4%), of whom 38 (58.5%) had resolution of the neutrophilic bronchitis after treatment with an antibiotic. Of these 38 patients, 13 (34%) showed eosinophilia.CONCLUSIONS:
A neutrophilic exacerbation of airway disease was observed to mask sputum eosinophilia in one-third of patients who had sputum cell counts available before and after antibiotic therapy. Hence, the absence of sputum eosinophilia during an infective exacerbation should not be used as an indication to reduce the dose of corticosteroids. To optimize therapy, repeat sputum cell count measurements are recommended after antibiotic treatment before changing corticosteroid treatment. 相似文献19.
Lata Jayaram N Renee Labiris Ann Efthimiadis Helen Vlachos-Mayer Frederick E Hargreave Andreas P Freitag 《Canadian respiratory journal》2007,14(2):99-103
BACKGROUND:
Technical factors relating to processing viscid sputum in cystic fibrosis (CF) and their influence on the reproducibility and validity of cell counts need to be evaluated. In addition, the methods need to be standardized so that they can be applied clinically and in research.OBJECTIVE:
To examine the efficiency, reliability and validity of processing small volumes of spontaneously expectorated sputum from subjects with CF.METHODS:
Sputum was collected from adults with CF (n=35) and compared with sputum from adults with infective bronchitis or bronchiectasis (IB/B) (n=16), or with asthma or chronic obstructive pulmonary disease (AS/COPD) (n=25). Selected sputum (100 mg to 200 mg) was processed with dithiothreitol (0.1%) and filtered. Total cell count (TCC) and viability were obtained in a counting chamber and cytospins were prepared and stained with Wright’s for a differential cell count. Sputum and filter remnant were processed for TCC, viability and differential cell count, and the efficiency was determined by comparing the mean loss in cell yield to the filter. Two different portions from the same sputum sample were processed for cell counts to determine reproducibility. Results were compared with those from IB/B and AS/COPD groups.RESULTS:
Efficiency of cell dispersal was excellent and similar to that in AS/COPD and IB/B groups. Reproducibility of cell counts from two portions of a sputum sample was high (R≥0.80). CF sputum demonstrated a raised TCC and neutrophilia similar to IB/B but significantly higher than AS/COPD.CONCLUSION:
The selection method of evaluating cell counts in viscid CF sputum is efficient, reproducible and valid. 相似文献20.
Liesel D��silva Nesreen Hassan Hong-Yu Wang Melanie Kjarsgaard Ann Efthimiadis Frederick E Hargreave Parameswaran Nair 《Canadian respiratory journal》2011,18(3):144-148