Safety of investigative bronchoscopy in the Severe Asthma Research Program.

TitleSafety of investigative bronchoscopy in the Severe Asthma Research Program.
Publication TypeJournal Article
Year of Publication2011
AuthorsMoore WC, Evans MD, Bleecker ER, Busse WW, Calhoun WJ, Castro M, Chung K F, Erzurum SC, Curran-Everett D, Dweik RA, Gaston B, Hew M, Israel E, Mayse ML, Pascual RM, Peters SP, Silveira L, Wenzel SE, Jarjour NN
Corporate AuthorsNational Heart, Lung, and Blood Institute's Severe Asthma Research Group
JournalJ Allergy Clin Immunol
Volume128
Issue2
Pagination328-336.e3
Date Published2011 Aug
ISSN1097-6825
KeywordsAdolescent, Adult, Asthma, Bronchi, Bronchial Provocation Tests, Bronchoscopy, Female, Forced Expiratory Volume, Humans, Male, Respiratory Function Tests, Severity of Illness Index, Young Adult
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.

DOI10.1016/j.jaci.2011.02.042
Alternate JournalJ. Allergy Clin. Immunol.
PubMed ID21496892