ORIGINAL STUDY
Safety of research bronchoscopy in mild-moderate and severe asthma
 
More details
Hide details
1
7th Pneumonology Medicine Department and Asthma Centre, Sotiria Chest Hospital, Athens, Greece
 
2
Athens University Pneumonology Medicine Department, Sotiria Chest Hospital, Athens, Greece
 
 
Corresponding author
Mina Gaga   

7th Pneumonology Medicine Dept. and Asthma Centre 152 Mesogeion Ave., Athens 115 27, Greece
 
 
Pneumon 2010;23(1):41-47
 
KEYWORDS
ABSTRACT
Objectives:
Fiberoptic bronchoscopy (FB) as a research tool has contributed considerably to the understanding of the pathogenesis of asthma, but there are concerns regarding its safety, especially in patients with severe asthma. The aim of this study was to document safety data on FB and sampling techniques in asthma research.

Methods:
A total of 75 subjects (36 mild-moderate asthmatics, 25 severe asthmatics and 14 healthy control subjects), participating in three studies, underwent research FB. Depending on the study, endobronchial and nasal biopsy, bronchioalveolar lavage (BAL) and bronchial brushing were performed, according to established guidelines. Pulmonary function tests were performed prior to bronchoscopy and 2 hours after the procedure. Daily peak expiratory flow (PEF) measurements were recorded 5 days before and 5 days after bronchoscopy in the 30 patients participating in the first two studies.

Results:
FB was tolerated well. None of the patients or healthy control subjects developed severe adverse reactions during or after bronchoscopy. Only two patients with severe asthma presented mild adverse events; one demonstrated immediate and complete occlusion of the middle lobe segmental bronchial lumen after BAL instillation and another developed mild desaturation (SaO2 91%). There were no significant changes in FEV1 and PEF measurements after bronchoscopy.

Conclusions:
Research FB can be performed safely in patients with asthma, including those with severe disease, with careful assessment and adherence to guidelines.

 
REFERENCES (31)
1.
Kirby JG, Hargreave FE, Gleich GJ, O’Byrne PM. Bronchoalveolar cell profiles of asthmatic and nonasthmatic subjects. Am Rev Respir Dis 1987; 136:379-383.
 
2.
Bousquet J, Chanez P, Lacoste JY, et al. Eosinophilic inflammation in asthma. N Engl J Med 11-10-1990; 323:1033-1039.
 
3.
Djukanovic R, Roche WR, Wilson JW, et al. Mucosal inflammation in asthma. Am Rev Respir Dis 1990; 142:434-457.
 
4.
Olivieri D, Foresi A. Correlation between cell content of bronchoalveolar lavage (BAL) and histologic findings in asthma. Respiration 1992;59 Suppl 1:3-5.
 
5.
O’byrne PM, Postma DS. The many faces of airway inflammation. Asthma and chronic obstructive pulmonary disease. Asthma Research Group. Am J Respir Crit Care Med 1999; 159: S41-S63.
 
6.
Lams BE, Sousa AR, Rees PJ, Lee TH. Subepithelial immunopathology of the large airways in smokers with and without chronic obstructive pulmonary disease. Eur Respir J 2000; 15:512-516.
 
7.
Jin F, Mu D, Chu D, Fu E, Xie Y, Liu T. Severe complications of bronchoscopy. Respiration 2008; 76:429-433.
 
8.
Sahn SA, Scoggin C. Fiberoptic bronchoscopy in bronchial asthma. A word of caution. Chest 1976; 69:39-42.
 
9.
Albertini RE, Harrell JH, Kurihara N, Moser KM. Arterial hypoxemia induced by fiberoptic bronchoscopy. JAMA 23-12-1974; 230:1666-1667.
 
10.
Pereira W, Kovnat DM, Khan MA, Iacovino JR, Spivack ML, Snider GL. Fever and pneumonia after flexible fiberoptic bronchoscopy. Am Rev Respir Dis 1975; 112:59-64.
 
11.
Rosenow EC, Andersen HA. Bronchoscopically induced bronchospasm. Chest 1976; 70:565-566.
 
12.
Djukanovic R, Wilson JW, Lai CK, Holgate ST, Howarth PH. The safety aspects of fiberoptic bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy in asthma. Am Rev Respir Dis 1991;143: 772-777.
 
13.
Van VT, Chanez P, Bousquet J, Lacoste JY, Michel FB, Godard P. Safety of bronchoalveolar lavage and bronchial biopsies in patients with asthma of variable severity. Am Rev Respir Dis 1992; 146:116-121.
 
14.
Elston WJ, Whittaker AJ, Khan LN, et al. Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma. Eur Respir J 2004; 24:375-377.
 
15.
Humbert M, Robinson DS, Assoufi B, Kay AB, Durham SR. Safety of fibreoptic bronchoscopy in asthmatic and control subjects and effect on asthma control over two weeks. Thorax 1996; 51:664-669.
 
16.
Kariyawasam HH, Aizen M, Kay AB, Robinson DS. Safety and tolerability of three consecutive bronchoscopies after allergen challenge in volunteers with mild asthma. Thorax 2007; 62:557-558.
 
17.
Busse WW, Wanner A, Adams K, et al. Investigative bronchoprovocation and bronchoscopy in airway diseases. Am J Respir Crit Care Med 1-10-2005; 172:807-816.
 
18.
Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention: NHLBI/WHO workshop Report: National Institutes of Health, National Heart, Lung and Blood Institute. NIH publication No. 02-3659; updated 2008. Available on www.ginasthma.org/.
 
19.
Gaga M, Lambrou P, Papageorgiou N, et al. Eosinophils are a feature of upper and lower airway pathology in non-atopic asthma, irrespective of the presence of rhinitis. Clin Exp Allergy 2000; 30:663-669.
 
20.
The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. European Network for Understanding Mechanisms of Severe Asthma. Eur Respir J 2003; 22:470-477.
 
21.
Panoutsakopoulou V, Xanthou G, Oikonomidou E, et al. Increased expression of Eta-1/osteopontin in asthma biopsies. Eur Respir J 2006; 28:236s.
 
22.
Xanthou G, Alissafi T, Semitekolou M, et al. Osteopontin has a crucial role in allergic airway disease through regulation of dendritic cell subsets. Nat Med 2007; 13:570-578.
 
23.
Investigative use of bronchoscopy, lavage and bronchial biopsies in asthma and other airways diseases. J Investig Allergol Clin Immunol 1991; 1:271-277.
 
24.
Milman N, Faurschou P, Grode G, Jorgensen A. Pulse oximetry during fibreoptic bronchoscopy in local anaesthesia: frequency of hypoxaemia and effect of oxygen supplementation. Respiration 1994; 61:342-347.
 
25.
Spanevello A, Migliori GB, Satta A, et al. Bronchoalveolar lavage causes decrease in PaO2, increase in (A-a) gradient value and bronchoconstriction in asthmatics. Respir Med 1998; 92:191- 197.
 
26.
Fonseca MT, Camargos PA, Abou TR, Le BM, Scheinmann P, de BJ. Incidence rate and factors related to post-bronchoalveolar lavage fever in children. Respiration 2007; 74:653-658.
 
27.
Wenzel SE, Szefler SJ, Leung DY, Sloan SI, Rex MD, Martin RJ. Bronchoscopic evaluation of severe asthma. Persistent inflammation associated with high dose glucocorticoids. Am J Respir Crit Care Med 1997; 156:737-743.
 
28.
Wenzel SE, Schwartz LB, Langmack EL, et al. Evidence that severe asthma can be divided pathologically into two inflammatory subtypes with distinct physiologic and clinical characteristics. Am J Respir Crit Care Med 1999; 160:1001-1008.
 
29.
Payne D, McKenzie SA, Stacey S, Misra D, Haxby E, Bush A. Safety and ethics of bronchoscopy and endobronchial biopsy in difficult asthma. Arch Dis Child 2001; 84:423-426.
 
30.
Balzar S, Wenzel SE, Chu HW. Transbronchial biopsy as a tool to evaluate small airways in asthma. Eur Respir J 2002; 20:254- 259.
 
31.
Pavord ID, Cox G, Thomson NC, et al. Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma. Am J Respir Crit Care Med2007; 176:1185-1191.
 
eISSN:1791-4914
ISSN:1105-848X
Journals System - logo
Scroll to top