Complications and discomfort after research bronchoscopy in the MicroCOPD study

Abstract

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.

Oxygen desaturation during flexible bronchoscopy with propofol sedation is associated with sleep apnea: the PROSA-Study

“…Hypoxia is the most commonly cited adverse event in patients undergoing bronchoscopy [16,17,28]. The occurrence of hypoxemia was highly prevalent during FB in our study, with an oxygen saturation of < 90% for ≥ 5 s measured in 132 patients (91%).…”

“…Nonetheless, the occurrence of hypoxemia during flexible bronchoscopy with sedation is similar in studies with and without supplemental oxygen [16,[33][34][35]. A recent study in Norway has shown that when patients chose to have no sedation, it significantly increased unplanned interventions during the bronchoscopy [17].…”

“…Flexible bronchoscopy (FB) is a generally safe minimally invasive procedure used to assess, diagnose and treat patients with respiratory disease [14]. Transient hypoxemia due to upper airway obstruction is known to occur in patients undergoing flexible bronchoscopy [15][16][17][18]. However, the association between transient hypoxemia during FB and the presence of sleep apnea remains unexplored.…”

Safety of research bronchoscopy with BAL in stable adult patients with cystic fibrosis

“…While research protocols often involve performing bronchoscopy on healthy volunteers without underlying lung disease, to investigate the pathophysiology it is often necessary to obtain clinical samples via BAL from human subjects with underlying lung disease. A recent study investigated the safety of research bronchoscopy in patients with COPD and asthma [ 30 ]. The results of this study include safety data of bronchsocopy with BAL as well as protected brush sampling and endobronchial biopsies.…”

“…To justify an elective invasive procedure for research with no direct clinical benefit the risks need to be minimal. Recent studies have evaluated the risk of research bronchoscopy in patients with COPD and asthma [ 30 , 31 ], however little is known about the risks of research bronchoscopy in adults with CF. We report here the outcomes of our single-institution research bronchoscopy program on CF and non-CF volunteers with an excellent safety profile.…”