Safety of investigative bronchoscopy in the Severe Asthma Research Program

Abstract

Background Investigative bronchoscopy was performed in a subset of participants in the Severe Asthma Research Program (SARP) to gain insights into the pathobiology of severe disease. We evaluated the safety aspects of this procedure in this cohort with specific focus on patients with severe asthma. Objective To prospectively evaluate changes in lung function and the frequency of adverse events related to investigative bronchoscopy. Methods Bronchoscopy was performed using a common Manual of Procedures. A subset of very severe asthma was defined by severe airflow obstruction, chronic oral corticosteroid use and recent asthma exacerbations. Subjects were monitored for changes in lung function and contacted by telephone for 3 days after the procedure. Results 436 subjects underwent bronchoscopy (97 normal, 196 not severe, 102 severe and 41 very severe asthma). Nine subjects were evaluated in hospital settings after bronchoscopy; seven of these were respiratory related events. Recent Emergency Department visits, chronic oral corticosteroid use and a history of pneumonia were more frequent in subjects who had asthma exacerbations after bronchoscopy. The fall in FEV1 following bronchoscopy was similar in the severe compared to milder asthma group. Pre-bronchodilator FEV1 was the strongest predictor of change in FEV1 after bronchoscopy with larger decreases observed in subjects with better lung function. Conclusions Bronchoscopy in severe asthma subjects was well tolerated. Asthma exacerbations were rare and reduction in pulmonary function after the procedure was similar to subjects with less severe asthma. With proper precautions, investigative bronchoscopy can be performed safely in severe asthma.

Sedation for Bronchoscopy and Complications in Obese Patients

“…This discrepancy suggests that airway dimensions (and potential obstruction by the bronchoscope) represented a clinically more important factor. Factors predicting desaturation with endoscopic procedures include a baseline oxygen saturation below 95%, an American Society of Anesthesiologist score of 3 or 4, sedation [33], respiratory disease with increasing desaturation seen with decreasing FEV 1 [34,35], old age, and anemia [36]. While we found no reports relating obesity to outcomes of bronchoscopy, a BMI >28 has been shown to be an independent risk factor for desaturation during gastrointestinal endoscopy [37].…”

Fevipiprant, a prostaglandin D 2 receptor 2 antagonist, in patients with persistent eosinophilic asthma: a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial

“…Asthma exacerbations are rare and reduction in pulmonary function after the procedure is similar to that in subjects with less severe asthma (Moore et al, 2011). Professor Brightling's group has undertaken in excess of 300 research bronchoscopies at the Glenfield Hospital in Leicester in the last 8 years.…”

Hospital Volume and Mortality following Diagnostic Bronchoscopy in Lung Cancer Patients: Data from a National Inpatient Database in Japan

“…Bronchoscopy has been safely performed in asthmatic patients [33-35], although up to 10% of the patients with asthma reportedly developed respiratory symptoms after bronchoscopy [28]. Improved all-cause mortality in asthmatic patients within 7 days after DB may have resulted from patient selection and from vigilant monitoring and careful management before and after bronchoscopy.…”