Acute pain perception during different sampling methods for respiratory culture in cystic fibrosis patients

Context: Reliable identification of lower respiratory tract pathogens is crucial in the management of cystic fibrosis (CF). The multitude of treatments and clinical procedures are a considerable burden and are potentially provoking pain. Objectives: As part of another study (NCT02363764), investigating the bacterial yield of three sampling methods, nasal swabs (NSs), cough swabs (CSs), and (induced) sputum samples ([I]SSs), in both expectorating patients (EPs) and non-expectorating patients (NEPs) with CF, the present study aimed to explore the prevalence of respiratory culture sampling-related pain as assessed by self-report within a cohort of children and adults. Methods: Literate patients with CF (aged six years or older) completed a questionnaire on pain perception related to the three aforementioned sampling methods (No/Yes; visual analogue scale for pain [VAS-Pain] [0–10 cm]). In addition, patients were asked to rank these methods by their own preference without taking into account the presumed bacterial yield. Results: In total, 119 questionnaires were returned. In the EPs-group, CS was most frequently (n%; mean VAS-Pain if pain [range]) reported as painful method: overall (n = 101; 12.9%; 1.8 [0.2–4.8]), children (n = 41; 22.0%; 1.4 [0.2–2.7]), and adults (n = 60; 6.7%; 2.5 [0.5–4.8]). Highest pain intensity scores were observed with NS overall (3.0%; 2.4 [0.3–6.2]) and in children (4.9%; 3.3 [0.3–6.2]), but not in adults (1.7%; 0.6 [–]).NEPs-children (n = 17) reported ISS most frequently and as most painful sampling method (17.6%; 2.0 [1.0–4.0]). The only NEP-adult did not perceive pain. NEPs preferred NS > CS > ISS (61.1%, 33.3%, 5.6%, respectively [P = 0.001]) as primary sampling method, whereas EPs preferred SS > NS > CS (65.7%, 26.3%, 8.1%, respectively [P < 0.0001]). Patients’ preference for a specific method inversely correlated to pain perception and intensity in EPs (φ = −0.155 [P = 0.007] and ρ = −0.926 [P = 0.008], respectively), but not in NEPs (φ = −0.226 [P = 0.097] and ρ = −0.135 [P = 0.798], respectively). Conclusion: A relatively large range of pain experiences was observed in patients with CF during respiratory culture sampling, which underlines the importance of individual pain assessment. Nevertheless, clinicians can confidently choose the sampling method based on validity over patients’ preference.