Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma

Abstract

Bronchoscopy with endobronchial biopsy (EBB) and/or bronchoalveolar lavage (BAL) has become an important research tool in asthma. A recent report has suggested audit and reporting of the safety of these procedures.A total of 159 asthmatic patients (84 males, 75 females), aged 18-52 (median 27) yrs, forced expiratory volume in one second 53-120 (median 88) % predicted, underwent 273 bronchoscopies in six clinical research studies. On 228 occasions, EBB and BAL were performed and, on 45 occasions, EBB was performed alone. On 48 occasions, bronchoscopy was performed 24 h post-allergen challenge.Adverse events occurred on 34 out of 273 occasions, none of which were following allergen challenge. Post-EBB and BAL, four patients developed pleuritic chest pain, shortness of breath and fever. A further two patients experienced pleuritic chest pain alone post-EBB/BAL. Bronchospasm or worsening of asthma symptoms occurred on 14 occasions, 13 post-EBB/BAL and on one occasion post-EBB alone. Fever/flu-like symptoms were reported on nine occasions following EBB and BAL. One subject had haemoptysis post-EBB/BAL, but required no intervention.In conclusion, bronchoscopy, endobronchial biopsy and bronchoalveolar lavage can be performed safely in asthmatic patients. Most of the complications were seen where bronchoalveolar lavage and endobronchial biopsy were both performed, suggesting that bronchoalveolar lavage accounts for most of the adverse events. Fibreoptic bronchoscopy with endobronchial biopsy (EBB) or bronchoalveolar lavage (BAL) has become an important tool in asthma research over the last two decades. These techniques have led to significant advances in the understanding of the pathogenesis of asthma and, in particular, the role of inflammatory cells and mediators [1][2][3][4]. In addition, intervention studies with new and existing treatments have provided useful insight into the mechanisms of action and efficacy of these treatments [5][6][7]. Following initial concerns over the safety of these techniques in asthmatic patients [8,9], consensus guidelines were published by the National Heart, Lung and Blood Institute [10,11]. More recently, three papers have reported bronchoscopy to be safe and well-tolerated in a relatively small number of asthmatic patients [12][13][14]. Despite this, concerns still remain and a recent report has suggested audit and continued reporting of the safety of these procedures. The current authors report their experience of adverse events related to fibreoptic bronchoscopy performed in asthmatic subjects taking part in six clinical research studies. Methods Study subjectsA total of 159 patients with asthma (84 males, 75 females), forced expiratory volume in one second (FEV1) 53-120 (median 88) % predicted, aged 18-52 (median 27) yrs were recruited for six studies and underwent a total of 273 bronchoscopies. On 228 occasions, subjects underwent EBB and BAL, 48 of which were performed 24 h post-allergen challenge. On 45 occasions, subjects had EBB alone. Subjects were recruited from ...

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“…A number of reports have suggested that bronchoscopy, including BAL and bronchial forceps and brush biopsy, can be safely performed for research purposes in patients with asthma and COPD (34,(71)(72)(73)(74). Repeated procedures have also been reported to be safe, at least in patients with mild asthma (59).…”

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