Spitfire - sputum induction trial for improved respiratory evaluation
Research type
Research Study
Full title
Assessing feasibility of induced sputum versus multilobe bronchoalveolar washings in immunocompromised haematology patients with suspected respiratory infection; a prospective, interventional feasibility trial
IRAS ID
301001
Contact name
Jonathan Ayling-Smith
Contact email
Sponsor organisation
Cardiff and Vale University Health Board
Duration of Study in the UK
1 years, 6 months, 1 days
Research summary
Most guidelines for the management of immunocompromised haematology patient advocate early initiation of antibiotics due to the recognised high mortality risk. Microbial culture is vital in streamlining antimicrobial choice and this is achieved through blood culture, culture of medical devices and respiratory sampling. A bronchial washing or lavage obtained through bronchoscopy is considered gold standard. Bronchoscopy can be inappropriate in patients due with a high oxygen demand or cardiovascular instability. As an in-demand procedure with finite operator availability, this aerosol generating procedure is often logistically difficult.
Induced sputum has become routine practice in cystic fibrosis care. Previous research has demonstrated an induced sputum sample is comparable to bronchial lavage for bacterial yield in cystic fibrosis patients. No research exists directly comparing the patient experience of induced sputum with bronchoscopy. Other research has shown benefit of induced sputum over bronchoscopy in obtaining samples for Mycobacterium culture in patients who aren’t producing sputum; which also would carry a more favourable risk profile to the staff due to aerosol generation.
The SPITFIRE trial aims to assess the feasibility and acceptability of induced sputum versus bronchoscopy in unwell haematology patients through patient questionnaires but with the added opportunity to ask the operators of the procedure their perception of tolerance and comfort. There is an anticipation that induced sputum carries a lower risk of adverse events and a much reduced requirement for sedating medications but this can also be evaluated. The SPITFIRE trial aims to assess and compare the diagnostic yield of these procedures to allow for comment as to how effective induced sputum is in the acute setting. As a feasibility study, SPITFIRE is not powered to allow for strong statistical conclusions based on diagnostic yield, however a positive correlation will allow for the planning of further research.
REC name
London - Queen Square Research Ethics Committee
REC reference
21/PR/0803
Date of REC Opinion
13 Jul 2021
REC opinion
Further Information Favourable Opinion