Safety of investigative bronchoscopy in the Severe Asthma Research Program
Wendy C Moore, Michael D Evans, Eugene R Bleecker, William W Busse, William J Calhoun, Mario Castro, Kian Fan Chung, Serpil C Erzurum, Douglas Curran-Everett, Raed A Dweik, Benjamin Gaston, Mark Hew, Elliot Israel, Martin L Mayse, Rodolfo M Pascual, Stephen P Peters, Lori Silveira, Sally E Wenzel, Nizar N Jarjour, National Heart, Lung, and Blood Institute's Severe Asthma Research Group, Elliot Israel, Bruce D Levy, Gautham Marigowda, Michael E Wechsler, Serpil C Erzurum, Raed A Dweik, Suzy A A Comhair, Emmea Cleggett-Mattox, Deepa George, Marcelle Baaklini, Daniel Laskowski, Anne M Fitzpatrick, Denise Whitlock, Shanae Wakefield, Kian F Chung, Mark Hew, Patricia Macedo, Sally Meah, Florence Chow, Eric Hoffman, Sally E Wenzel, Fernando Holgion, Jen Chamberlin, William J Calhoun, Bill T Ameredes, Benjamin Gaston, W Gerald Teague, Denise Thompson-Batt, William W Busse, Nizar Jarjour, Ronald Sorkness, Sean Fain, Erin Billmeyer, Cheri Swenson, Gina Crisafi, Laura Frisque, Dan Polk, Eugene R Bleecker, Deborah Meyers, Wendy Moore, Stephen Peters, Rodolfo M Pascual, Annette Hastie, Gregory Hawkins, Jeffrey Krings, Regina Smith, Mario Castro, Leonard Bacharier, Jaime Tarsi, Douglas Curran-Everett, Ruthie Knowles, Maura Robinson, Lori Silveira, Patricia Noel, Robert Smith, Wendy C Moore, Michael D Evans, Eugene R Bleecker, William W Busse, William J Calhoun, Mario Castro, Kian Fan Chung, Serpil C Erzurum, Douglas Curran-Everett, Raed A Dweik, Benjamin Gaston, Mark Hew, Elliot Israel, Martin L Mayse, Rodolfo M Pascual, Stephen P Peters, Lori Silveira, Sally E Wenzel, Nizar N Jarjour, National Heart, Lung, and Blood Institute's Severe Asthma Research Group, Elliot Israel, Bruce D Levy, Gautham Marigowda, Michael E Wechsler, Serpil C Erzurum, Raed A Dweik, Suzy A A Comhair, Emmea Cleggett-Mattox, Deepa George, Marcelle Baaklini, Daniel Laskowski, Anne M Fitzpatrick, Denise Whitlock, Shanae Wakefield, Kian F Chung, Mark Hew, Patricia Macedo, Sally Meah, Florence Chow, Eric Hoffman, Sally E Wenzel, Fernando Holgion, Jen Chamberlin, William J Calhoun, Bill T Ameredes, Benjamin Gaston, W Gerald Teague, Denise Thompson-Batt, William W Busse, Nizar Jarjour, Ronald Sorkness, Sean Fain, Erin Billmeyer, Cheri Swenson, Gina Crisafi, Laura Frisque, Dan Polk, Eugene R Bleecker, Deborah Meyers, Wendy Moore, Stephen Peters, Rodolfo M Pascual, Annette Hastie, Gregory Hawkins, Jeffrey Krings, Regina Smith, Mario Castro, Leonard Bacharier, Jaime Tarsi, Douglas Curran-Everett, Ruthie Knowles, Maura Robinson, Lori Silveira, Patricia Noel, Robert Smith
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.
Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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Source: PubMed