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. 2011 Aug;128(2):328-336.e3.
doi: 10.1016/j.jaci.2011.02.042. Epub 2011 Apr 15.

Safety of Investigative Bronchoscopy in the Severe Asthma Research Program

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Free PMC article

Safety of Investigative Bronchoscopy in the Severe Asthma Research Program

Wendy C Moore et al. J Allergy Clin Immunol. .
Free PMC article

Abstract

Background: Investigative bronchoscopy was performed in a subset of participants in the Severe Asthma Research Program 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 evaluate prospectively changes in lung function and the frequency of adverse events related to investigative bronchoscopy.

Methods: Bronchoscopy was performed by 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: A total of 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; 7 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 after bronchoscopy was similar in the severe and milder asthma groups. Prebronchodilator FEV₁ was the strongest predictor of change in FEV₁ after bronchoscopy with larger decreases observed in subjects with better lung function.

Conclusion: Bronchoscopy in subjects with severe asthma was well tolerated. Asthma exacerbations were rare, and reduction in pulmonary function after the procedure was similar to that in subjects with less severe asthma. With proper precautions, investigative bronchoscopy can be performed safely in severe asthma.

Figures

FIGURE 1
FIGURE 1
Change in FEV1 after bronchoscopy in the four groups of subjects. Shown is the % change in % predicted FEV1 from the first FEV1 before albuterol administration to the lowest FEV1 following bronchoscopy. There was no statistically significant difference in the distribution of % change in % predicted FEV1 among the groups (p = 0.30)
FIGURE 2
FIGURE 2
Change in FEV1 after bronchoscopy for individual subjects. There is a mild relationship (r = -0.21, p < 0.0001) between better baseline lung function and greater % decrease in FEV1. The closed circles represent the subjects who had asthma exacerbations, the closed triangles are subjects who went to the emergency department with other complaints.

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