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Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma

¹ Dept of Respiratory Medicine, London Chest Hospital, and ² Lung Pathology, Dept of Gene Therapy, Imperial College School of Medicine, Royal Brompton Hospital, London, UK

CORRESPONDENCE: N.C. Barnes, Dept of Respiratory Medicine, London Chest Hospital, Bonner Road, London, E2 9JX, UK. Fax: 44 2089832279. E-mail: neil.barnes@bartsandthelondon.nhs.uk

Keywords: Adverse events, asthma, biopsy, bronchoalveolar lavage, bronchoscopy

Received: June 5, 2003
Accepted April 23, 2004

Financial support was provided by the British Lung Foundation, GlaxoSmithKline, Astra Zeneca, Merck and departmental funds.

Bronchoscopy with endobronchial biopsy (EBB) and/or bronchoalveolar lavage (BAL) has become an important research tool in asthma. A recent report has suggested audit and reporting of the safety of these procedures.

A total of 159 asthmatic patients (84 males, 75 females), aged 18–52 (median 27) yrs, forced expiratory volume in one second 53–120 (median 88) % predicted, underwent 273bronchoscopies in six clinical research studies. On 228 occasions, EBB and BAL were performed and, on 45 occasions, EBB was performed alone. On 48 occasions, bronchoscopy was performed 24 h post-allergen challenge.

Adverse events occurred on 34 out of 273 occasions, none of which were following allergen challenge. Post-EBB and BAL, four patients developed pleuritic chest pain, shortness of breath and fever. A further two patients experienced pleuritic chest pain alone post-EBB/BAL. Bronchospasm or worsening of asthma symptoms occurred on 14 occasions, 13 post-EBB/BAL and on one occasion post-EBB alone. Fever/flu-like symptoms were reported on nine occasions following EBB and BAL. One subject had haemoptysis post-EBB/BAL, but required no intervention.

In conclusion, bronchoscopy, endobronchial biopsy and bronchoalveolar lavage can be performed safely in asthmatic patients. Most of the complications were seen where bronchoalveolar lavage and endobronchial biopsy were both performed, suggesting that bronchoalveolar lavage accounts for most of the adverse events.

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