Purpose
Some patients with diffuse interstitial lung disease (ILD) undergo bronchoscopy with transbronchial biopsy (TBB) as part of their diagnostic evaluation. It is unclear what the incidence and risk factors for pneumothorax (PTX) following TBB are in this patient population.
Methods
Ninety-seven subjects with pulmonary fibrosis who underwent a research bronchoscopy with TBB as part of the multicenter Correlating Outcomes with Biochemical Markers to Estimate Time-progression in Idiopathic Pulmonary Fibrosis (COMET) trial were retrospectively reviewed. We compared subjects who developed a PTX during research bronchoscopy with TBB versus those who did not.
Results
Seven patients (7.2%) experienced a PTX during research bronchoscopy with TBB. Subjects who experienced PTX during TBB had significantly lower DLCO percent predicted (29 ± 8 versus 45 ± 15, P=0.006) and had lower resting room air saturation of peripheral oxygen (SPO2) on 6-minute walk testing (91±10 versus 95±3, P=0.02). No differences between groups were found with respect to age, gender, race, BMI, HRCT characteristics, or number of transbronchial biopsies performed.
Conclusion
The incidence of PTX following research bronchoscopy with TBB in patients with pulmonary fibrosis was found to be 7.2% in this study. Patients who developed a pneumothorax had greater impairments in gas exchange at baseline evidenced by a lower DLCO % predicted and a lower resting room air SPO2 when compared to subjects without PTX as a complication.
Background: Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic lung disease that ultimately results in death. The rate of disease progression is variable among patients and difficult to predict. Quantitative computed tomography (CT) analysis offers an objective evaluation of lung parenchyma that could provide additional prognostic information. Purpose: To evaluate quantitative CT indices as predictors for mortality and hospitalization. Methods: 43 patients were selected from the Pennsylvania IPF registry. Patients had to have pulmonary function tests (PFT), a 6-minute walk (6MW), and a non-contrast CT thorax within a 3-month period. PFT and 6MWT were performed according to ATS criteria. All CT scans were done at Temple University Hospital in supine position at full inspiration. CT scans were analyzed using Slicer v2.8, available at , and evaluated for fibrosis and emphysema. Fibrosis was quantitated using skewness and kurtosis of each patient's CT histogram. Mortality was determined using the Social Security Death Index. Patients were grouped by time to death from baseline CT date: death in less than 1 year, death between 1-2 years, and alive greater than 2 years. ANOVA was used to compare the amount of emphysema and fibrosis between groups. The amount of emphysema, skewness, and kurtosis was also compared between patients who died or were hospitalized and those that did not using ANOVA. Results: Baseline demographics can be seen in Table 1. Table 2 shows comparison of baseline PFTs and CT analysis between patients that died in less than 1 year, between 1-2 years, and survived greater than 2 years. Patients that died in less than 1 year from their initial CT scan had significantly more emphysema in the upper and middle lobes compared to those that were alive for greater than 2 years. Those patients had a significantly lower DLCO at baseline. There were no significant differences in the amount of fibrosis (skewness and kurtosis). Patients that died or were hospitalized had significantly more emphysema in the upper lobes, 4% vs. 0.8%, compared to those who did not, p-value 0.048. There were no significant differences in fibrosis between these groups. Conclusions: Patients that died in less than one year from their CT scan date had significantly more emphysema in the upper lobes compared to patients that survived more than 2 years. The degree of emphsyema in the upper lobes should be considered when evaluating patients with IPF and may portend a worse survival.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.