No abstract

No abstract

Flexible bronchoscopy is an essential, established and expanding tool in respiratory medicine. Its practice, however, needs to be safe, effective and for the right indications to maximise clinical utility. This guideline is based on the best available evidence and is a revised update of the British Thoracic Society guideline on diagnostic flexible bronchoscopy.Flexible bronchoscopy in adults is an essential, established and expanding tool in respiratory medicine. This new guideline aims to ensure that bronchoscopy remains a safe and effective procedure. Since the publication of the previous British Thoracic Society guideline on diagnostic flexible bronchoscopy in 2001 1 there has been a large amount of new evidence which has been incorporated into this guideline.

This new guideline covers the rapidly advancing field of interventional bronchoscopy using flexible bronchoscopy. It includes the use of more complex diagnostic procedures such as endobronchial ultrasound, interventions for the relief of central airway obstruction due to malignancy and the recent development of endobronchial therapies for chronic obstructive pulmonary disease and asthma. The guideline aims to help all those who undertake flexible bronchoscopy to understand more about this important area. It also aims to inform respiratory physicians and other specialists dealing with lung cancer of the procedures possible in the management and palliation of central airway obstruction. The guideline covers transbronchial needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration, electrocautery/diathermy, argon plasma coagulation and thermal laser, cryotherapy, cryoextraction, photodynamic therapy, brachytherapy, tracheobronchial stenting, electromagnetic navigation bronchoscopy, endobronchial valves for emphysema and bronchial thermoplasty for asthma.This guideline is based on the best available evidence. The methodology used to write the guideline adheres strictly to the criteria as set by the Appraisal of Guidelines Research and Evaluation (AGREE) collaboration http://www.agreecollaboration.org/1/agreeguide/. Three hundred and eighty-seven papers were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists. A web-based guideline development tool (http://www. bronchoscopy-guideline.org/) enabled each pair of reviewers to collaborate online. The reliability of the evidence in each individual study was graded using the SIGN critical appraisal checklist. The body of evidence for each recommendation was summarised into evidence tables, formulated into evidence statements and graded using the SIGN grading system into recommendations.

The full British Thoracic Society (BTS) guideline for the use of long-term macrolides in adults with respiratory disease is published in Thorax. The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline. The appendices are available in the full guideline and online appendices are available on the BTS website. This is the first BTS guideline to use the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach as part of the process of guideline development and the guideline was used to pilot the new methodology.

Conclusions 1) Delay within-patient was significantly longer than withinoncology (p<0.0001). 2) Over 60% patients visited their GP more than once. 3) Delay and stage were unrelated in our study. 4) Chest symptoms increased considerably during the pathway to treatment. 5) A number of common symptoms were associated with advanced disease.