{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:09:56Z","timestamp":1783098596914,"version":"3.54.6"},"reference-count":75,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Currently, there are no guidelines or consensus statements about the usage of inhaled mucoactive drugs in pediatric respiratory disease conditions from an Indian perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop a practical consensus document to help pediatricians in clinical decision-making when choosing an appropriate mucoactive drug for the management of specific respiratory disease conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A committee of nine experts with significant experience in pediatric respiratory disease conditions and a microbiological expert constituted the panel. An electronic search of the PubMed\/MEDLINE, Cochrane Library, Scopus, and Embase databases was undertaken to identify relevant articles. Various combinations of keywords such as inhaled, nebulized, mucoactive, mucolytic, mucokinetic, expectorants, mucoregulators, mucociliary clearance, respiratory disorders, pediatric, cystic fibrosis (CF), non-CF bronchiectasis, acute wheezing, asthma, primary ciliary dyskinesia (PCD), critically ill, mechanical ventilation, tracheomalacia, tracheobronchomalacia, esophageal atresia (EA), tracheoesophageal fistula (TEF), acute bronchiolitis, sputum induction, guideline, and management were used. Twelve questions were drafted for discussion. A roundtable meeting of experts was conducted to arrive at a consensus. The level of evidence and class of recommendation were weighed and graded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Inhaled mucoactive drugs (hypertonic saline, dry powder mannitol, and dornase alfa) can enhance mucociliary clearance in children with CF. Experts opined that hypertonic saline could be beneficial in non-CF bronchiectasis, acute bronchiolitis, and PCD. The current state of evidence is inadequate to support the use of inhaled mucoactive drugs in asthma, acute wheezing, tracheomalacia, tracheobronchomalacia, and EA with TEF.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1322360","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T06:24:56Z","timestamp":1701671096000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Expert group recommendation on inhaled mucoactive drugs in pediatric respiratory diseases: an Indian perspective"],"prefix":"10.3389","volume":"11","author":[{"given":"Meenu","family":"Singh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sneha","family":"Varkki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilin","family":"Kinimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi R.","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagdish Prasad","family":"Goyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mushtaq","family":"Bhat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeshwar","family":"Dayal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawan","family":"Kalyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitender","family":"Gairolla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indu","family":"Khosla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.prrv.2020.06.007","article-title":"Rational use of mucoactive medications to treat pediatric airway disease","volume":"36","author":"Linssen","year":"2020","journal-title":"Paediatr Respir Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"399","DOI":"10.2147\/COPD.S144312","article-title":"Management of airway mucus hypersecretion in chronic airway inflammatory disease: Chinese expert consensus (English edition)","volume":"13","author":"Shen","year":"2018","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"ESC Guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2019","journal-title":"Eur Heart J"},{"key":"B4","author":"Sch\u00fcnemann","year":""},{"key":"B5","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1136\/bmj.328.7454.1490","article-title":"Grading quality of evidence and strength of recommendations","volume":"328","author":"Atkins","year":"2004","journal-title":"Br Med J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1002\/ame2.12180","article-title":"A review of cystic fibrosis: basic and clinical aspects","volume":"4","author":"Chen","year":"2021","journal-title":"Anim Models Exp Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"CD001506","DOI":"10.1002\/14651858.CD001506.pub5","article-title":"Nebulised hypertonic saline for cystic fibrosis","volume":"6","author":"Wark","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B8","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1016\/S2213-2600(19)30187-0","article-title":"Inhaled hypertonic saline in preschool children with cystic fibrosis (SHIP): a multicentre, randomised, double-blind, placebo-controlled trial","volume":"7","author":"Ratjen","year":"2019","journal-title":"Lancet Respir Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1016\/S2213-2600(21)00546-4","article-title":"The effect of inhaled hypertonic saline on lung structure in children aged 3-6 years with cystic fibrosis (SHIP-CT): a multicentre, randomised, double-blind, controlled trial","volume":"10","author":"Tiddens","year":"2022","journal-title":"Lancet Respir Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"CD008816","DOI":"10.1002\/14651858.CD008816.pub4","article-title":"Timing of hypertonic saline inhalation for cystic fibrosis","volume":"2","author":"Elkins","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"B11","doi-asserted-by":"publisher","first-page":"CD008649","DOI":"10.1002\/14651858.CD008649.pub4","article-title":"Inhaled mannitol for cystic fibrosis","volume":"5","author":"Nevitt","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e85616","DOI":"10.5812\/compreped.85616","article-title":"The efficacy of nebulized soluble mannitol and comparison with 5% hypertonic saline on pulmonary function of children with cystic fibrosis","volume":"10","author":"Sadr","year":"2019","journal-title":"J Compr Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"CD001127","DOI":"10.1002\/14651858.CD001127.pub5","article-title":"Dornase alfa for cystic fibrosis","volume":"3","author":"Yang","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1111\/j.1651-2227.1999.tb01265.x","article-title":"Systematic review of N-acetylcysteine in cystic fibrosis","volume":"88","author":"Duijvestijn","year":"1999","journal-title":"Acta Paediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1016\/j.jcf.2020.07.009","article-title":"A four-week trial of hypertonic saline in children with mild cystic fibrosis lung disease: effect on mucociliary clearance and clinical outcomes","volume":"19","author":"Donaldson","year":"2020","journal-title":"J Cyst Fibros"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1164\/rccm.201807-1203OC","article-title":"Preventive inhalation of hypertonic saline in infants with cystic fibrosis (PRESIS). A randomized, double-blind, controlled study","volume":"199","author":"Stahl","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1056\/NEJMoa043900","article-title":"A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis","volume":"354","author":"Elkins","year":"2006","journal-title":"N Engl J Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.jcf.2017.02.003","article-title":"Inhaled dry powder mannitol in children with cystic fibrosis: a randomised efficacy and safety trial","volume":"16","author":"De Boeck","year":"2017","journal-title":"J Cyst Fibros"},{"key":"B19","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1164\/rccm.201109-1666OC","article-title":"Long-term inhaled dry powder mannitol in cystic fibrosis: an international randomized study","volume":"185","author":"Aitken","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1056\/NEJM199409083311003","article-title":"Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. The pulmozyme study group","volume":"331","author":"Fuchs","year":"1994","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1067\/mpd.2001.118570","article-title":"A two-year randomized, placebo-controlled trial of dornase alfa in young patients with cystic fibrosis with mild lung function abnormalities","volume":"139","author":"Quan","year":"2001","journal-title":"J Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1183\/09031936.06.00069005","article-title":"Inhaled heparin in cystic fibrosis","volume":"27","author":"Serisier","year":"2006","journal-title":"Eur Respir J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1753466619866102","DOI":"10.1177\/1753466619866102","article-title":"Nebulized hypertonic saline in noncystic fibrosis bronchiectasis: a comprehensive review","volume":"13","author":"M\u00e1iz Carro","year":"2019","journal-title":"Ther Adv Respir Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"CD010337","DOI":"10.1002\/14651858.CD010337.pub2","article-title":"Interventions for bronchiectasis: an overview of cochrane systematic reviews","volume":"2015","author":"Welsh","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1111\/resp.13047","article-title":"Mucoactive agents for chronic, non-cystic fibrosis lung disease: a systematic review and meta-analysis","volume":"22","author":"Tarrant","year":"2017","journal-title":"Respirology"},{"key":"B26","year":""},{"key":"B27","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1002\/ppul.25206","article-title":"Effectiveness of hypertonic saline nebulization in airway clearance in children with non-cystic fibrosis bronchiectasis: a randomized control trial","volume":"56","author":"Anuradha","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.rmed.2004.05.006","article-title":"Evaluation of nebulised hypertonic saline (7%) as an adjunct to physiotherapy in patients with stable bronchiectasis","volume":"99","author":"Kellett","year":"2005","journal-title":"Respir Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1016\/j.rmed.2011.07.019","article-title":"Nebulised 7% hypertonic saline improves lung function and quality of life in bronchiectasis","volume":"105","author":"Kellett","year":"2011","journal-title":"Respir Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.rmed.2011.12.021","article-title":"The long-term effect of inhaled hypertonic saline 6% in non-cystic fibrosis bronchiectasis","volume":"106","author":"Nicolson","year":"2012","journal-title":"Respir Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1378\/chest.12-1763","article-title":"Phase 3 randomized study of the efficacy and safety of inhaled dry powder mannitol for the symptomatic treatment of non-cystic fibrosis bronchiectasis","volume":"144","author":"Bilton","year":"2013","journal-title":"Chest"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1136\/thoraxjnl-2014-205587","article-title":"Inhaled mannitol for non-cystic fibrosis bronchiectasis: a randomised, controlled trial","volume":"69","author":"Bilton","year":"2014","journal-title":"Thorax"},{"key":"B33","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1164\/ajrccm.154.2.8756815","article-title":"Short-term recombinant human DNase in bronchiectasis. Effect on clinical state and in vitro sputum transportability","volume":"154","author":"Wills","year":"1996","journal-title":"Am J Respir Crit Care Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1378\/chest.113.5.1329","article-title":"Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. RhDNase study group","volume":"113","author":"O\u2019Donnell","year":"1998","journal-title":"Chest"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e1397","DOI":"10.1542\/peds.2011-3376","article-title":"Hypertonic saline and acute wheezing in preschool children","volume":"129","author":"Ater","year":"2012","journal-title":"Pediatrics"},{"key":"B36","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1002\/ppul.23924","article-title":"Does nebulized hypertonic saline shorten hospitalization in young children with acute viral wheezing?","volume":"53","author":"Kanjanapradap","year":"2018","journal-title":"Pediatr Pulmonol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"3714","DOI":"10.1002\/ppul.25653","article-title":"Bronchodilator response to albuterol nebulized with hypertonic saline in asthmatic children","volume":"56","author":"Teper","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1183\/09031936.00176608","article-title":"Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children","volume":"34","author":"Barbato","year":"2009","journal-title":"Eur Respir J"},{"key":"B39","doi-asserted-by":"publisher","first-page":"omz135","DOI":"10.1093\/omcr\/omz135","article-title":"Management of a child with primary ciliary dyskinesia","volume":"2020","author":"Kumar","year":"2020","journal-title":"Oxf Med Case Rep"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1016\/j.rmed.2007.05.014","article-title":"Long-term use of nebulized human recombinant DNase1 in two siblings with primary ciliary dyskinesia","volume":"101","author":"El-Abiad","year":"2007","journal-title":"Respir Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1601770","DOI":"10.1183\/13993003.01770-2016","article-title":"A randomised controlled trial on the effect of inhaled hypertonic saline on quality of life in primary ciliary dyskinesia","volume":"49","author":"Paff","year":"2017","journal-title":"Eur Respir J"},{"key":"B42","doi-asserted-by":"publisher","first-page":"A7768","DOI":"10.1164\/ajrccm-conference.2020.201.1_MeetingAbstracts.A7768","article-title":"Initiation of nebulized hypertonic saline in infants with primary ciliary dyskinesia","author":"Kaspy","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1183\/09031936.93.01020161","article-title":"The clinical effect and the effect on the ciliary motility of oral N-acetylcysteine in patients with cystic fibrosis and primary ciliary dyskinesia","volume":"1","author":"Stafanger","year":"1988","journal-title":"Eur Respir J"},{"key":"B44","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1136\/thoraxjnl-2019-214355","article-title":"Mucoactive agents for acute respiratory failure in the critically ill: a systematic review and meta-analysis","volume":"75","author":"Anand","year":"2020","journal-title":"Thorax"},{"key":"B45","doi-asserted-by":"publisher","first-page":"586","DOI":"10.4187\/respcare.04418","article-title":"Prophylactic use of nebulized hypertonic saline in mechanically ventilated children: a randomized blinded pilot study","volume":"61","author":"Shein","year":"2016","journal-title":"Respir Care"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2947","DOI":"10.1080\/14767058.2017.1359826","article-title":"Nebulized hypertonic saline to prevent ventilator associated pneumonia in premature infants, a randomized trial","volume":"31","author":"Ezzeldin","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B47","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/ppul.20298","article-title":"Recombinant human deoxyribonuclease shortens ventilation time in young, mechanically ventilated children","volume":"41","author":"Riethmueller","year":"2006","journal-title":"Pediatr Pulmonol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1089\/jamp.2011.0954","article-title":"Dornase alpha compared to hypertonic saline for lung atelectasis in critically ill patients","volume":"25","author":"Youness","year":"2012","journal-title":"J Aerosol Med Pulm Drug Deliv"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e","DOI":"10.1016\/j.jcrc.2012.09.015","article-title":"Inhaled dornase alfa (Pulmozyme) as a noninvasive treatment of atelectasis in mechanically ventilated patients","volume":"28","author":"Zitter","year":"2013","journal-title":"J Crit Care"},{"key":"B50","first-page":"309","article-title":"Evaluation of the effect of nebulized N-acetylcysteine on respiratory secretions in mechanically ventilated patients: randomized clinical trial","volume":"40","author":"Masoompour","year":"2015","journal-title":"Iran J Med Sci"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1900382","DOI":"10.1183\/13993003.00382-2019","article-title":"ERS Statement on tracheomalacia and bronchomalacia in children","volume":"54","author":"Wallis","year":"2019","journal-title":"Eur Respir J"},{"key":"B52","doi-asserted-by":"publisher","first-page":"512","DOI":"10.3389\/fped.2019.00512","article-title":"Tracheomalacia and tracheobronchomalacia in pediatrics: an overview of evaluation, medical management, and surgical treatment","volume":"7","author":"Kamran","year":"2019","journal-title":"Front Pediatr"},{"key":"B53","doi-asserted-by":"publisher","first-page":"CD005304","DOI":"10.1002\/14651858.CD005304.pub3","article-title":"Interventions for primary (intrinsic) tracheomalacia in children","volume":"10","author":"Goyal","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"B54","doi-asserted-by":"publisher","first-page":"2635","DOI":"10.1016\/j.jpedsurg.2020.04.013","article-title":"Evaluation of nebulized N-acetyl cysteine in outcome of esophageal atresia with tracheoesophegeal fistula","volume":"55","author":"Singh","year":"2020","journal-title":"J Pediatr Surg"},{"key":"B55","doi-asserted-by":"publisher","first-page":"232","DOI":"10.4103\/0971-9261.59612","article-title":"Esophageal atresia with tracheo-esophageal fistula: role of nebulized N-acetylcysteine in the outcome","volume":"14","author":"Pandey","year":"2009","journal-title":"J Indian Assoc Pediatr Surg"},{"key":"B56","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1002\/ppul.21073","article-title":"Recombinant human DNase in children with airway malacia and lower respiratory tract infection","volume":"44","author":"Boogaard","year":"2009","journal-title":"Pediatr Pulmonol"},{"key":"B57","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s13052-017-0396-2","article-title":"Respiratory problems in children with esophageal atresia and tracheoesophageal fistula","volume":"43","author":"Porcaro","year":"2017","journal-title":"Ital J Pediatr"},{"key":"B58","doi-asserted-by":"publisher","first-page":"CD006458","DOI":"10.1002\/14651858.CD006458.pub4","article-title":"Nebulised hypertonic saline solution for acute bronchiolitis in infants","volume":"12","author":"Zhang","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"B59","doi-asserted-by":"publisher","first-page":"168","DOI":"10.18203\/2349-3291.ijcp20195748","article-title":"Effect of nasal suction on reliving feeding difficulty in children affected with bronchiolitis","volume":"7","author":"Joshi","year":"2020","journal-title":"Int J Contemp Pediatr"},{"key":"B60","doi-asserted-by":"publisher","first-page":"CD006458","DOI":"10.1002\/14651858.CD006458.pub5","article-title":"Nebulised hypertonic saline solution for acute bronchiolitis in infants","volume":"4","author":"Zhang","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B61","doi-asserted-by":"publisher","first-page":"CD008395","DOI":"10.1002\/14651858.CD008395.pub2","article-title":"Nebulised deoxyribonuclease for viral bronchiolitis in children younger than 24 months","volume":"11","author":"Enriquez","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"B62","first-page":"408","article-title":"Effectiveness of nebulized N-acetylcysteine solution in children with acute bronchiolitis","volume":"24","author":"Naz","year":"2014","journal-title":"J Coll Physicians Surg Pak"},{"key":"B63","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1002\/ppul.24066","article-title":"Impact of hypertonic saline on hospitalization rate in infants with acute bronchiolitis: a meta-analysis","volume":"53","author":"Zhang","year":"2018","journal-title":"Pediatr Pulmonol"},{"key":"B64","doi-asserted-by":"publisher","first-page":"80","DOI":"10.3329\/bjch.v43i2.42550","article-title":"Comparative efficacy of nebulized 7% hypertonic saline versus 0.9% normal saline with salbutamol in children with acute bronchiolitis","volume":"43","author":"Islam","year":"2019","journal-title":"Bangladesh J Child Health"},{"key":"B65","doi-asserted-by":"publisher","first-page":"e31270","DOI":"10.1097\/MD.0000000000031270","article-title":"3% Nebulized hypertonic saline versus normal saline for infants with acute bronchiolitis: a systematic review and meta-analysis of randomized controlled trials","volume":"101","author":"Yu","year":"2022","journal-title":"Medicine (Baltim)"},{"key":"B66","doi-asserted-by":"publisher","first-page":"44s","DOI":"10.1183\/09031936.02.00004402","article-title":"Sputum induction in children","volume":"37","author":"Gibson","year":"2002","journal-title":"Eur Respir J Suppl"},{"key":"B67","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1002\/ppul.10226","article-title":"Safety and use of sputum induction in children with cystic fibrosis","volume":"35","author":"Suri","year":"2003","journal-title":"Pediatr Pulmonol"},{"key":"B68","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1007\/s00408-017-0008-3","article-title":"Hypertonic saline as a useful tool for sputum induction and pathogen detection in cystic fibrosis","volume":"195","author":"Ferreira","year":"2017","journal-title":"Lung"},{"key":"B69","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/S2213-2600(18)30171-1","article-title":"The CF-sputum induction trial (CF-SpIT) to assess lower airway bacterial sampling in young children with cystic fibrosis: a prospective internally controlled interventional trial","volume":"6","author":"Ronchetti","year":"2018","journal-title":"Lancet Respir Med"},{"key":"B70","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1183\/09031936.95.08040559","article-title":"Some technical factors influencing the induction of sputum for cell analysis","volume":"8","author":"Popov","year":"1995","journal-title":"Eur Respir J"},{"key":"B71","doi-asserted-by":"publisher","first-page":"163","DOI":"10.4046\/trd.2014.76.4.163","article-title":"Usefulness of sputum induction with hypertonic saline in a real clinical practice for bacteriological yields of active pulmonary tuberculosis","volume":"76","author":"Seong","year":"2014","journal-title":"Tuberc Respir Dis (Seoul)"},{"key":"B72","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1086\/516782","article-title":"Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate","volume":"44","author":"Brown","year":"2007","journal-title":"Clin Infect Dis"},{"key":"B73","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/s12291-010-0091-1","article-title":"Molecular basis of cystic fibrosis disease: an Indian perspective","volume":"25","author":"Prasad","year":"2010","journal-title":"Indian J Clin Biochem"},{"key":"B74","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/s13312-015-0563-8","article-title":"Non-cystic fibrosis bronchiectasis in children: clinical profile, etiology and outcome","volume":"52","author":"Kumar","year":"2015","journal-title":"Indian Pediatr"},{"key":"B75","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s12890-018-0638-0","article-title":"Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis","volume":"18","author":"Chandrasekaran","year":"2018","journal-title":"BMC Pulm Med"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1322360\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T06:24:59Z","timestamp":1701671099000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1322360\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,4]]},"references-count":75,"alternative-id":["10.3389\/fped.2023.1322360"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1322360","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,4]]},"article-number":"1322360"}}