Department of Clinical Science, University of Bergen, Bergen, Norway
Department of Clinical Science, University of Bergen, Bergen, Norway.
BMJ Open Respir Res. 2020 Mar;7(1). doi: 10.1136/bmjresp-2019-000449.
Data on discomfort and complications from research bronchoscopy in chronic obstructive pulmonary disease (COPD) and asthma is limited. We present complications and discomfort occurring within a week after bronchoscopy, and investigate personal and procedural risk factors.
239 subjects with COPD, asthma or without lung disease underwent research bronchoscopies as part of a microbiome study of the lower airways (the MicroCOPD study). Bronchoscopy was done in the supine position with oral scope insertion with the option of light conscious alfentanil sedation. Sampling consisted of protected specimen brushes, bronchoalveolar lavage, small volume lavage and for some, endobronchial biopsies. Bleeding, desaturation, cough, haemodynamic changes, dyspnoea and other events that required an unplanned intervention or early termination of bronchoscopy were prospectively recorded. Follow-up consisted of a telephone interview where subjects rated discomfort and answered questions about fever sensation and respiratory symptoms in the week following bronchoscopy.
An unplanned intervention or early termination of bronchoscopy was required in 25.9% of bronchoscopies. Three subjects (1.3%) experienced potentially severe complications, of which all recovered without sequelae. COPD subjects experienced more dyspnoea than controls. Sedation and lower age was associated with less unplanned intervention or premature termination. About half of the subjects (47.7%) reported fever. Discomfort was associated with postprocedural fever, dread of bronchoscopy, higher score on the COPD Assessment Test and never-smoking. In subjects undergoing more than one bronchoscopy, the first bronchoscopy was often predictive for complications and postprocedural fever in the repeated bronchoscopy.
Research bronchoscopies were not associated with more complications or discomfort in COPD subjects. 47.7% experienced postbronchoscopy fever sensation, which was associated with discomfort.
有关慢性阻塞性肺疾病（COPD）和哮喘患者研究性支气管镜检查的不适和并发症的数据有限。我们报告了支气管镜检查后一周内发生的并发症和不适，并研究了个人和程序危险因素。
239 名 COPD、哮喘或无肺部疾病患者作为下呼吸道微生物组研究（MicroCOPD 研究）的一部分接受了研究性支气管镜检查。支气管镜检查在仰卧位进行，经口插入内镜，可选择轻度清醒阿芬太尼镇静。采样包括保护标本刷、支气管肺泡灌洗、小容量灌洗以及对某些患者进行支气管内活检。出血、氧饱和度下降、咳嗽、血流动力学变化、呼吸困难和其他需要计划外干预或提前终止支气管镜检查的事件均被前瞻性记录。随访包括电话访谈，患者在支气管镜检查后一周内对不适进行评分，并回答有关发热感觉和呼吸系统症状的问题。
25.9%的支气管镜检查需要计划外干预或提前终止。3 名患者（1.3%）发生潜在严重并发症，所有患者均无后遗症恢复。COPD 患者比对照组更易出现呼吸困难。镇静和较低的年龄与较少的计划外干预或提前终止相关。约一半的患者（47.7%）报告有发热。不适与术后发热、对支气管镜检查的恐惧、COPD 评估测试评分较高和从不吸烟有关。在接受多次支气管镜检查的患者中，第一次支气管镜检查常可预测后续支气管镜检查的并发症和术后发热。
研究性支气管镜检查在 COPD 患者中并未增加并发症或不适。47.7%的患者出现支气管镜检查后发热感觉，与不适有关。
