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In individuals with idiopathic pulmonary fibrosis (IPF), bronchoscopy appears to be a safe and well tolerated procedure according to the results of an analysis published in the American Journal of Respiratory and Critical Care Medicine.1
Recognizing that diagnosing interstitial lung disease (ILD) can be challenging, researchers sought to confirm the safety of using bronchoalveolar lavage (BAL) in patients with IPF by analyzing the study cohorts from the Prospective Observation of Fibrosis in Lung Clinical Endpoints trials (ClinicalTrials.gov Identifiers: NCT01134822 and NCT01110694).
The study authors noted that guidelines suggest bronchoscopy and cellular analysis of BAL should be used in patients with newly identified ILD for whom a differential diagnosis includes fibrotic hypersensitivity pneumonitis.2 In addition, IPF guidelines provide a conditional recommendation to perform BAL in cases of newly detected ILD of unknown cause when the computerized tomography pattern is not one of definite usual interstitial pneumonia.3 However, not all clinicians perform diagnostic bronchoscopy because of the potential increased risk of acute exacerbations or acute respiratory deterioration in patients with IPF.4,5
A total of 223 patients with IPF who received bronchoscopy with BAL at baseline were analyzed and followed at 1, 3, and 6 months, and then annually for 3 years.1 Patients were matched with 391 other patients with IPF who did not undergo BAL. All patients in the bronchoscopy cohort tolerated the procedure well with no immediate (<72 hours) complications; within the first 30 days post-BAL, only 6 patients (2.7%) reported complications.
There was no difference in 30-, 60-, and 90-day all-cause mortality in bronchoscopy cohort compared with the no-bronchoscopy cohort. All-cause mortality at 90 days was 1.4% in the bronchoscopy cohort and 3.6% in the no-bronchoscopy cohort, and there was no significant difference (P =.45) in overall mortality between patients who underwent bronchoscopy and those who did not.
“While we demonstrate no negative safety signal, we do not address cost effectiveness; something which may impact local decisions to perform BAL in the diagnostic assessment of ILD,” the study authors noted.1
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
References
1. Molyneaux PL, Smith JJ, Saunders P, et al. Bronchoalveolar lavage is safe and well tolerated in individuals with idiopathic pulmonary fibrosis: an analysis of the PROFILE study. Am J Respir Crit Care Med. Published online August 28, 2020. doi:10.1164/rccm.202004-1138LE
2. Raghu G, Document S, Remy-Jardin M, et al. Diagnosis of hypersensitivity pneumonitis in adults: an official ATS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2020;202(3):e36-e69.
3. Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. An Official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2018;198:e44-e68.
4. Hiwatari N, Shimura S, Takishima T, Shirato K. Bronchoalveolar lavage as a possible cause of acute exacerbation in idiopathic pulmonary fibrosis patients. Tohoku J Exp Med. 1994;174:379-386.
5. Sakamoto K, Taniguchi H, Kondoh Y, et al. Acute exacerbation of IPF following diagnostic bronchoalveolar lavage procedures. Respir Med. 2012;106:436-442.
