Bronchoscopy Safety in Patients With Chronic Obstructive Lung Disease

Bellinger, Christina; Khan, Irtaza; Chatterjee, Arjun B.; Haponik, Edward F.

doi:10.1097/lbr.0000000000000333

Cited by 30 publications

(27 citation statements)

References 13 publications

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“…The only statistically significant difference between COPD subjects and controls was more postprocedural dyspnoea in COPD subjects. These findings are in accordance with a recent study that reported similar safety profiles in patients with and without COPD,15 and previous findings of more respiratory complications in COPD patients following bronchoscopy 16. Predictors of unplanned intervention or early procedure termination were lack of sedation and higher age.…”

Section: Discussionsupporting

confidence: 92%

Complications and discomfort after research bronchoscopy in the MicroCOPD study

et al. 2020

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background Data on discomfort and complications from research bronchoscopy in chronic obstructive pulmonary disease (COPD) and asthma is limited. We present complications and discomfort occurring within a week after bronchoscopy, and investigate personal and procedural risk factors. Methods 239 subjects with COPD, asthma or without lung disease underwent research bronchoscopies as part of a microbiome study of the lower airways (the MicroCOPD study). Bronchoscopy was done in the supine position with oral scope insertion with the option of light conscious alfentanil sedation. Sampling consisted of protected specimen brushes, bronchoalveolar lavage, small volume lavage and for some, endobronchial biopsies. Bleeding, desaturation, cough, haemodynamic changes, dyspnoea and other events that required an unplanned intervention or early termination of bronchoscopy were prospectively recorded. Follow-up consisted of a telephone interview where subjects rated discomfort and answered questions about fever sensation and respiratory symptoms in the week following bronchoscopy. results An unplanned intervention or early termination of bronchoscopy was required in 25.9% of bronchoscopies. Three subjects (1.3%) experienced potentially severe complications, of which all recovered without sequelae. COPD subjects experienced more dyspnoea than controls. Sedation and lower age was associated with less unplanned intervention or premature termination. About half of the subjects (47.7%) reported fever. Discomfort was associated with postprocedural fever, dread of bronchoscopy, higher score on the COPD Assessment Test and never-smoking. In subjects undergoing more than one bronchoscopy, the first bronchoscopy was often predictive for complications and postprocedural fever in the repeated bronchoscopy. conclusion Research bronchoscopies were not associated with more complications or discomfort in COPD subjects. 47.7% experienced postbronchoscopy fever sensation, which was associated with discomfort.

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Section: Discussionsupporting

confidence: 92%

Complications and discomfort after research bronchoscopy in the MicroCOPD study

et al. 2020

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“…Obtaining AM by BAL can be difficult in severe COPD or during exacerbations because of increased risk of bronchoscopy (45). This study is the first to show a correlation between phagocytic capacity in paired AM and MDM ( Figure 5), suggesting MDM could be used as a model of AM phagocytosis.…”

Section: Discussionmentioning

confidence: 67%

Human Rhinovirus Impairs the Innate Immune Response to Bacteria in Alveolar Macrophages in Chronic Obstructive Pulmonary Disease

Finney

Belchamber

Fenwick

et al. 2019

Am J Respir Crit Care Med

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Rationale: Human rhinovirus (HRV) is a common cause of chronic obstructive pulmonary disease (COPD) exacerbations. Secondary bacterial infection is associated with more severe symptoms and delayed recovery. Alveolar macrophages clear bacteria from the lung and maintain lung homeostasis through cytokine secretion. These processes are defective in COPD. The effect of HRV on macrophage function is unknown. Objectives: To investigate the effect of HRV on phagocytosis and cytokine response to bacteria by alveolar macrophages and monocyte-derived macrophages (MDM) in COPD and healthy control subjects. Methods: Alveolar macrophages were obtained by bronchoscopy and MDM by adherence. Macrophages were exposed to HRV16 (multiplicity of infection 5), polyinosinic:polycytidylic acid (poly I:C) 30 mg/ml, IFN-b 10 mg/ml, IFN-g 10 mg/ml, or medium control for 24 hours. Phagocytosis of fluorescently labeled Haemophilus influenzae or Streptococcus pneumoniae was assessed by fluorimetry. CXCL8 (IL-8), IL-6, TNF-a (tumor necrosis factor-a), and IL-10 release was measured by ELISA. Measurements and Main Results: HRV significantly impaired phagocytosis of H. influenzae by 23% in MDM (n = 37; P = 0.004) and 18% in alveolar macrophages (n = 20; P , 0.0001) in COPD. HRV also significantly reduced phagocytosis of S. pneumoniae by 33% in COPD MDM (n = 20; P = 0.0192). There was no effect in healthy control subjects. Phagocytosis of H. influenzae was also impaired by poly I:C but not IFN-b or IFN-g in COPD MDM. HRV significantly reduced cytokine responses to H. influenzae. The IL-10 response to H. influenzae was significantly impaired by poly I:C, IFN-b, and IFN-g in COPD cells. Conclusions: HRV impairs phagocytosis of bacteria in COPD, which may lead to an outgrowth of bacteria. HRV also impairs cytokine responses to bacteria via the TLR3/IFN pathway, which may prevent resolution of inflammation leading to prolonged exacerbations in COPD.

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“…Patients with COPD and chronic kidney disease showed an increased risk of experiencing cardiopulmonary events during a bronchoscopy. While bronchoscopy is generally safe in most patients with COPD 27 , patients with severe to very severe COPD could have more frequent respiratory complications than patients without COPD 28 . In addition, OSA coexisting with COPD, called COPD-OSA overlap syndrome 29 , might affect the risk of cardiopulmonary events occurring during bronchoscopy.…”

Section: Discussionmentioning

confidence: 99%

Prediction of cardiopulmonary events using the STOP-Bang questionnaire in patients undergoing bronchoscopy with moderate sedation

Cho

Choi

Park

et al. 2020

Sci Rep

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the objective was to evaluate the prevalence of patients at a high risk of having oSA by using a screening questionnaire and to investigate whether the questionnaire can predict patients who are at risk of cardiopulmonary events occurring during a bronchoscopy under sedation. We prospectively enrolled consecutive adult patients who underwent flexible bronchoscopies under moderate sedation. The snoring, tiredness, observed apnea, high blood pressure-body mass index, age, neck circumference and gender (Stop-Bang) questionnaire was used to identify patients at a high (score ≥ 3 of 8) or low risk (score < 3 of 8) of having OSA. The cardiopulmonary events included hypoxemia and hypotension. Multivariable logistic regression was performed with variables selected by the least absolute shrinkage and selection operator. The prevalence of a STOP-Bang score of ≥ 3 was 67.2% (195/290), and 36.9% (107/290) experienced cardiopulmonary events. The multivariable analysis adjusting for chronic obstructive pulmonary disease, chronic kidney disease, baseline Spo 2 , and procedure time revealed that a STOP-Bang score of ≥ 3 was significantly associated with cardiopulmonary events in a subgroup of patients without a history of cerebrovascular disease (adjusted odds ratio, 1.94; 95% confidence interval, 1.06-3.54). The STOP-Bang questionnaire can predict cardiopulmonary events occurring during this procedure. Trial registration: NCT03325153. Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway obstruction occurring during sleep 1. It is suggested that about 1 billion adults worldwide may be affected by OSA 2. The prevalence of OSA-defined as more than five apneas or hypopneas per hour of sleep plus excessive daytime sleepiness-was 12.5% in men and 5.9% in women in the middle to old age general population 3,4. Overnight polysomnography is the gold standard for the diagnosis of OSA. However, it is time-consuming, labor-intensive, and costly 5,6. Although patients with OSA are at an increased risk of developing perioperative cardiac and pulmonary complications 7-10 , approximately 60% of those with moderate to severe OSA are not recognized preoperatively 11,12. Patients with OSA may experience obstructive episodes during procedures while under moderate sedation 13. However, the rate of adverse events in undiagnosed OSA patients undergoing bronchoscopies under moderate sedation remains poorly described. In early 2000, Sharma et al. reported that OSA was detected in threequarters of 23 patients without a previous diagnosis of sleep apnea while undergoing outpatient bronchoscopy or colonoscopy 14. Recently, a study with obese patients having bronchoscopy under moderate sedation showed that the incidences of procedural complications were similar between obese and non-obese patients. However, a subset (7%) of patients with previous polysomnography-proven OSA were more likely to have earlier termination

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Bronchoscopy Safety in Patients With Chronic Obstructive Lung Disease

Cited by 30 publications

References 13 publications

Complications and discomfort after research bronchoscopy in the MicroCOPD study

Complications and discomfort after research bronchoscopy in the MicroCOPD study

Human Rhinovirus Impairs the Innate Immune Response to Bacteria in Alveolar Macrophages in Chronic Obstructive Pulmonary Disease

Prediction of cardiopulmonary events using the STOP-Bang questionnaire in patients undergoing bronchoscopy with moderate sedation

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