Safety of Bronchoalveolar Lavage and Bronchial Biopsies in Patients with Asthma of Variable Severity

Publisher Website
Google Scholar
Abstract
The safety of fiberoptic bronchoscopy, bronchoalveolar lavage (BAL), and bronchial biopsies has been questioned in asthma, and current recommendations indicate that bronchoscopies should only be performed in mild to moderate asthma. Moreover, in most studies patients receive premedication with nebulized bronchodilators that may enhance the safety of the procedures. The purpose of this study was to determine (1) whether the overall safety of fiberoptic bronchoscopy, BAL, and bronchial biopsies in mild to moderate asthma could be extended to patients with more severe asthma and (2) whether these procedures are safe without premedication with nebulized bronchodilators. A group of 50 patients with asthma of variable severity (FEV1 ranging from 37 to 107% of predicted values) and 25 healthy volunteers were studied. Bronchoscopy, BAL (250 ml), and four bronchial biopsies were performed in a standardized manner, without premedication with a nebulized bronchodilator, by the same investigator. Safety was assessed by clinical follow-up, continuous recording of arterial oxygen saturation during the procedure with a digital oximeter, and measuring FEV1 FEF25–75, and FVC just before and 5 min after bronchoscopy. Arterial oxygen saturation decreased in asthmatic patients from 97% (range 91 to 99%) (T1) to 92% (range 79 to 98%) (T8) (ANOVA, Fisher's PLSD) and in control subjects from 97% (range 94 to 99%) (T1) to 93% (range 88 to 98%) (T8) (ANOVA, Fisher's PLSD). The fall in arterial oxygen saturation was not significantly different between asthmatic and normal subjects, and there was no correlation between arterial oxygen desaturation and the severity of asthma. In asthma, FVC decreased significantly from 86.2 ± 14.6 to 64.0 ± 17.1% (p = 0.0001) and FEV1 decreased significantly from 75.6 ± 16.8 to 55.3 ± 17.2% (p = 0.0002). The fall in FEV1 was not related to the severity of asthma. In control subjects, FVC decreased significantly from 99.6 ± 14.3 to 82.3 ± 19.0% (p = 0.0125) and FEV1 decreased significantly from 97.1 ± 14.0 to 80.3 ± 16.2% (p = 0.0071). The percentages of falls in FVC, FEV1, and FEF25–75 after endoscopic procedure were significantly greater in asthmatic than in control subjects (p = 0.0121, p = 0.0124, and p = 0.0217, respectively). There were no significant falls in the ratios FEV1/FVC or FEF25–75/FVC, either in asthmatic or in control subjects. BAL and biopsies are well tolerated in asthmatic patients without premedication with a nebulized bronchodilator, even if they have severe asthma or a low FEV1 before bronchoscopy.