At NJH, they teach you how to induce sputum via nebulized saline. They *seldom* fail to get a sample. Further, at NJH, they told me they rarely, if ever, do bronchoscopies, nor do they recommend them, as bronchoscopies are not without risk including 'popping a lung', not to mention the cognitive effects from anesthesia.

If they did not even recommend trying sputum induction as the first means of obtaining a sputum sample, I would question both their competence and ethics. I say ethics because it's common knowledge that in the highly marketized US healthcare system, it is far more profitable to bill for bronchoscopies than to do sputum inductions.

I am someone who rarely naturally produces sputum, but I have been able to successfully submit monthly samples for NTM assessment using sputum induction. Interestingly, when I've gone to NJH, there have been occasions where the sample looks relatively clear, but has been sufficient for their purposes.