{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:21:44Z","timestamp":1788315704471,"version":"build-2803163510"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Ratchadapisek Research Funds"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delayed pulmonary tuberculosis (PTB) diagnosis, especially with limited bronchoscopy resources, worsens outcomes and increases transmission risks. Sputum induction offers a noninvasive and effective alternative. We investigated whether adding nebulized bronchodilators improves sputum induction effectiveness for presumed PTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a randomized controlled trial at King Chulalongkorn Memorial Hospital, Thailand, 204 adults with presumed PTB and negative Xpert MTB\/RIF Ultra results or inadequate sputum production were enrolled between July and October 2024. Participants were randomly assigned to conventional sputum induction (3% hypertonic saline alone; n = 101) or bronchodilator-enhanced induction (nebulized bronchodilator plus 3% hypertonic saline; n = 103). The primary outcome was TB diagnosis by Xpert MTB\/RIF assay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Tuberculosis detection rates by Xpert MTB\/RIF were significantly higher in the bronchodilator-enhanced group (30.1%; number needed to diagnose [NND] = 4) versus the conventional group (17.8%; NND = 6), with a 12.3% difference (relative risk [RR], 1.68; 95% confidence interval [CI] 1.01\u20132.80). The group receiving bronchodilator co-administration showed a trend toward higher mycobacterial culture positivity (RR 1.49; 95% CI .93\u20132.41) and a lower need for bronchoscopy (RR 0.41; 95% CI .15\u20131.12). They also experienced fewer adverse events and required fewer induction attempts, significantly assisting us to be able to provide early treatment to the patients (median 4.5 vs 14 days; P &amp;lt; .01). Subgroup analysis revealed a significant benefit among outpatients (RR 1.86; 95% CI 1.00\u20133.48).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bronchodilator-enhanced sputum induction demonstrated superiority over conventional induction, with higher diagnostic yield, fewer adverse events, fewer invasive procedures, and significantly earlier TB treatment initiation, supporting its potential as a new standard for TB diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>Thai Clinical Trials Registry (TCTR20240709001), registered on 9 July 2024.<\/jats:p>\n                  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