Comprehensive Research Bronchoscopy Procedure Safe, Tolerable in COPD

A comprehensive research bronchoscopy procedure, including oral sampling, bronchoalveolar lavage (BAL), endobronchial biopsy, and brushing can be safely performed to investigate the lower airways in chronic obstructive pulmonary disease (COPD), according to a study published in Annals of the American Thoracic Society.

Using the Subpopulations and Intermediate Outcome Measures in COPD study (SPIROMICS; ClinicalTrials.gov Identifier: NCT01969344) protocol, participating study centers collected tongue scrapings, oral rinses, and bronchoscopy with airway inspection, BAL, protected brushings, and endobronchial biopsies from 215 participants. Exclusion criteria included age >80 years, history of cardiac disease, or other comorbid conditions severe enough to increase risks, partial pressure of oxygen <60 mm Hg or oxygen saturation <88% on room air, postbronchodilator forced expiratory volume in 1 second (FEV₁) <30% predicted, or treatment with warfarin or clopidogrel. Participants were monitored for adverse events during and after examination.

The bronchoscopy was generally well-tolerated by the participants. BAL yielded 50% (111±57 mL) of the 223±65 mL infusate. Brushes were completed in 98% of participants, and endobronchial biopsies were performed in 82% of the procedures. Adverse events were more common in participants with COPD (defined as FEV₁/forced vital capacity <0.7) than in those without COPD (11.8% vs 2.6%, P =.008). The following factors were associated with clinically significant adverse events: female sex (risk ratio [RR], 1.10; 95% CI, 1.02-1.19), self-reported asthma (RR, 1.17; 95% CI, 1.02-1.34), bronchodilator reversibility (RR 1.17; 95% CI, 1.04-1.32), FEV₁ (RR 0.97; 95% CI, 0.95-0.99), and secretions (RR 1.85; 95% CI, 1.08-3.16) or friability (RR 1.64; 95% CI, 1.04-2.57).

Limitations of this study included failure to achieve enrollment goal, inability to comment on the technical aspect of bronchoscopy use because investigators did not capture data on oral vs nasal route, and the lack of data on doses or medication types used for sedation during the bronchoscopy procedure. However, no participants in the study required reversal agents for sedation-related complications.

Researchers concluded that their protocol was generally well-tolerated by patients and can be safely performed in an outpatient setting.

Reference

Wells JM, Arenberg DA, Barjaktarevic I, et al. Safety and tolerability of comprehensive research bronchoscopy in COPD: Results from the SPIROMICS bronchoscopy sub-study [published online January 17, 2019]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201807-441OC