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

Abstract

Data on adverse events from research bronchoscopy with bronchoalveolar lavage (BAL) in patients with cystic fibrosis (CF) is lacking. As research bronchoscopy with BAL is useful for isolation of immune cells and investigation of CF lung microbiome, we sought to investigate the safety of bronchoscopy in adult patients with CF. Between November 2016 and September 2019, we performed research bronchoscopies on CF subjects (32) and control subjects (82). Control subjects were nonsmokers without respiratory disease. CF subjects had mild or moderate obstructive lung disease (FEV1 > 50% predicted) and no evidence of recent CF pulmonary exacerbation. There was no significant difference in the age or sex of each cohort. Neither group experienced life threatening adverse events. The number of adverse events was similar between CF and control subjects. The most common adverse events were sore throat and cough, which occurred at similar frequencies in control and CF subjects. Fever and headache occurred more frequently in CF subjects. However, the majority of fevers were seen in CF subjects with FEV1 values below 65% predicted. We found that CF subjects had similar adverse event profiles following research bronchoscopy compared to healthy subjects. While CF subjects had a higher rate of fevers, this adverse event occurred with greater frequency in CF subjects with lower FEV1. Our data demonstrate that research bronchoscopy with BAL is safe in CF subjects and that safety profile is improved if bronchoscopies are limited to subjects with an FEV1 > 65% predicted.

The clinical yield of bronchoscopy in the management of cystic fibrosis: A retrospective multicenter study

“…BAL identified certain pathogens missed on routine sputum cultures, mostly Aspergillus species in young non‐expectorating children, and rare pulmonary pathogens in older patients. Bronchoscopy was safe, did not adversely affect pulmonary functions, and was not associated with significant adverse reactions, similar to some recently published data 21,22 . Our findings provide reassurance for the use of bronchoscopy as a diagnostic tool in the clinical management of pwCF and future studies assessing intrapulmonary biomarkers.…”

“…Bronchoscopy was safe, did not adversely affect pulmonary functions, and was not associated with significant adverse reactions, similar to some recently published data. 21 , 22 Our findings provide reassurance for the use of bronchoscopy as a diagnostic tool in the clinical management of pwCF and future studies assessing intrapulmonary biomarkers.…”

Advanced models for respiratory disease and drug studies

“…Obtaining enough tissues to perform multiple analyses is challenging. Also, the patients that undergo lung biopsy may have complications of hemoptysis, pulmonary venous air embolism, pulmonary hemorrhage, and pneumothorax 130,131 . Thus, optimizing the use of airway and lung biopsies for studying different respiratory diseases is needed.…”

Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review

“…Finally, in cystic fibrosis, FB may allow for a more accurate diagnosis of lower respiratory tract infections, guiding the choice of antimicrobials in non-sputum producers[ 16 ]. However, according to the latest Cochrane systematic review on this topic[ 17 ], there is no clear evidence to support its routine use compared to standard practice, in which treatment choice is based on the results of oropharyngeal culture and clinical symptoms.…”