What am I doing wrong? How to get a good sputum specimen for a culture

@irenea8 I've tried/used both albuterol via nebulizer and inhaler, and levalbuterol via nebulizer for some time. I have not noticed any long term side effects.

For levalbuterol ask for 0.63/3ml script. Many doctors unwittingly prescribe 1.26/3ml, which makes many nervous and shaky.

Before a breathing test I might use albuterol as I think it works slightly better but day to day levalbuterol open things up with no anxiety or shakiness. It took my body a few days of getting used to it, however.

I was able to get needed specimens using a nebulizer with 7% saline solution. This was done in the Respiratory Therapy Department.

I am having the same problem recently. No matter what I do, nebulize, don't nebulize, spit out before huff coughing, use AD, use aerobika, for the past five samples it's always the same. I've gotten the dreaded "the presence of 10 or more epithelial cells per low power field indicates contamination with oropharyngeal flora making the specimen unsuitable for processing". It's frustrating because my pulmonologist suspects that the achromobacter colonization that showed up in late 2022 but never caused problems, has finally had an impact given that I've been bringing up blood and am quite fatigued. She wants to me to take antibiotics but I'm really hesitant without knowing what bug I've got. Any additional suggestions would be greatly appreciated. And as a side note I almost never bring up mucous in the morning, but lots at the end of the day. I only use Severent diskus inhaler plus 7% saline.

Once any bleeding subsides, you might want to take a bronchodilator then in 5 mins try nebbing 2 vials of 7% saline back to back. Give the saline a few minutes to draw out the sputum before clearing. Try different positions - on your back, on your side, tummy down. Normal breathing 3 breaths (I mean completely normal like when you're watching TV). Then slow deep breaths in held for 5 sec, then out S L O W L Y for 5 secs (do that 3 times) followed by 3 more normal breaths. Nothing should be forced. After that try a huff cough (fogging up the mirror cough.) Easy does it.

I know it’s frustrating but you are not alone. I cannot get a sample for a culture no matter what I do. They do a broncoscopy on me for a sample every couple of years to see if treatment is working.

Scoop did you find the nebulized form or inhaler form more helpful before trying to get the sputum sample. I also dread getting the sputum sample - no matter what I do I am almost dry nothing comes that looks good for my northwestern hospital in Chicago lab.

@lilianna It depends on the day if I use an albuterol inhaler or levalbuterol via nebulizer. They have both been effective for me. For sputum culture I try first thing in the morning after taking a glass of water and mucinex and the neb routine. Please keep in mind that I have had bronchiectasis for some time and have not tested positive for NTM etc so far. With airway clearance twice daily I am trying to keep it that way.

After watching Dr. Shane's video on airway clearance I have eliminated the aerobika during the saline neb, so inhaling directly into my lungs and not through the aerobika. So much better and the gunk comes up easier. In fact I have eliminated the aerobika from my routine altogether. (Amen one less item to clean/sterilize). Instead, I use well controlled breath holds and releases and postural drainage. After upright and lying down autogenic drainage, I position myself on my sleeping wedge on each side to create a downward slope for anymore gunk to drain. It takes a few breath holds, squeezes and the gunk moves down and out. I hope this helps you somehow.

If you continue to have issues with not being able to get a sample, how about trying 2 vials of saline in a row?

I have had success nebulizing 2 vials (4cc each) of 7% saline to increase what I cough up. To deal with the oropharyngeal contamination, I keep start with 2 glasses in front of me, one empty and one with sterile water. Before I cough each time, I rinse my mouth with the sterile water and spit in the other glass. This routine has gotten me acceptable samples. I was intimidated for a long time by the requirement for submitting at least 5 cc, but I found that if the sample was good quality, they would process a smaller sample.
Good luck!

When I was waiting for my ten day evaluation at National Jewish Health They requested I send a sputum sample prior. I explained to them that I was absolutely unable to get any sputum sample accomplished. They told me to call the hospitals in area and get them to do a “forced sputum sample”. I called numerous and anurse in infectious disease called several. Only one place even knew what a forced sputum was,and the only one that did wa shocked,and said we only do those on inpatients in the ICU.
When arrived for my eval they sent me to respiratory therapy fora forced sputum…1.25/3ml levabuterol (to open airway) followed by 7% sodium chloride (to force the sputum out). I was skeptical since I could get nothing ever. Did both nebulizers and within minutes had a sputum sample. I have now been doing airway clearance for 6 years and rarely fail to get sputum out. Never had a sputum sample rejected since doing airway clearance. Note: Several times I tried doing the 7% saline without the levabuterol nebulizer first (short on time) and got a mild reaction of shortnessof breath everytime. Docs explained the necessity of the levabuterol first to open airway, and that should not happen with levabuterol first. Now I never do without levabuterol first and have not had any issues. Good luck.

Can I ask you what kind of 'wedge' do you use and how do you place it. I'd like to start postural drainage but don't know where to begin. Many thanks.