Pepsin measured in induced sputum - a test for pulmonary aspiration in children?

Purpose The purpose of this study was to investigate if pepsin measured in sputum is a useful marker of pulmonary aspiration secondary to gastroesophageal reflux (GER) in children. It is possible that the induced sputum procedure could cause GER and invalidate the results. The hypothesis stated that healthy children (those without history of respiratory or gastroesophageal symptoms) would not have pepsin detected in induced sputum. Methods Children attending surgical outpatients in the Royal Belfast Hospital for Sick Children (Belfast, Northern Ireland) were recruited. After spirometry, sputum was obtained by induction with hypertonic 3% saline. Spirometry was repeated, and complications were noted. An “in-house” enzyme-linked immunosorbent assay was used to measure pepsin concentration in sputum. The lower limit of detection of pepsin was 1.19 ng/mL. Results Children (n = 21) aged 4 to 16 years were recruited. Twenty children completed the study. No adverse effects were reported. Pepsin was detected in 17 (85%) of 20 sputum samples. Conclusions The act of sputum induction appears to induce physiologic GER in a healthy childhood population. The analysis of pepsin in sputum obtained by sputum induction is therefore not useful in the investigation of reflux-related respiratory disease.

Questions of 'h' in Northern Ireland: Breathing New Life on the Aspiration Theory

This paper considers existing ideas concerning pronunciation of the letter name for (LNH) in Northern Irish English (NIE). Traditionally, the status of LNH realisation as an ethnic marker has gone unquestioned: Catholics are thought to say [het&Mac186;] while the Protestant norm is assumed to be [etS]. The phonetic difference between these realisations is consistently described as word-initial aspiration versus non-aspiration, with aspiration attributed exclusively to Irish language influence. Here, we show that an explanation based on aspiration alone is phonologically unsatisfying and question whether aspiration is, in fact, an Irish language or ethnically dictated phenomenon. It is further suggested here that the overwhelming stigmatisation of LNH realisation may be responsible for blocking a potential sound change in NIE. While this paper is not intended as a detailed account of ethnolinguistic differences in NI phonology, it engages critically with the over-simplistic and widespread notion that LNH realisation is a result of transfer from the Irish language to the English used by Catholics in Northern Ireland.