Safety of investigative bronchoscopy in the Severe Asthma Research Program

Wendy C. Moore, Michael D. Evans, Eugene R. Bleecker, William W. Busse, William J. Calhoun, Mario Castro, Kian Fan Chung, Serpil C. Erzurum, Douglas Curran-Everett, Raed A. Dweik, Benjamin Gaston, Mark Hew, Elliot Israel, Martin L. Mayse, Rodolfo M. Pascual, Stephen P. Peters, Lori Silveira, Sally E. Wenzel, Nizar N. Jarjour

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Abstract

Background: Investigative bronchoscopy was performed in a subset of participants in the Severe Asthma Research Program to gain insights into the pathobiology of severe disease. We evaluated the safety aspects of this procedure in this cohort with specific focus on patients with severe asthma. Objective: To evaluate prospectively changes in lung function and the frequency of adverse events related to investigative bronchoscopy. Methods: Bronchoscopy was performed by using a common manual of procedures. A subset of very severe asthma was defined by severe airflow obstruction, chronic oral corticosteroid use, and recent asthma exacerbations. Subjects were monitored for changes in lung function and contacted by telephone for 3 days after the procedure. Results: A total of 436 subjects underwent bronchoscopy (97 normal, 196 not severe, 102 severe, and 41 very severe asthma). Nine subjects were evaluated in hospital settings after bronchoscopy; 7 of these were respiratory-related events. Recent emergency department visits, chronic oral corticosteroid use, and a history of pneumonia were more frequent in subjects who had asthma exacerbations after bronchoscopy. The fall in FEV1 after bronchoscopy was similar in the severe and milder asthma groups. Prebronchodilator FEV 1 was the strongest predictor of change in FEV1 after bronchoscopy with larger decreases observed in subjects with better lung function. Conclusion: Bronchoscopy in subjects with severe asthma was well tolerated. Asthma exacerbations were rare, and reduction in pulmonary function after the procedure was similar to that in subjects with less severe asthma. With proper precautions, investigative bronchoscopy can be performed safely in severe asthma.

Original languageEnglish (US)
Pages (from-to)328-336.e3
JournalJournal of Allergy and Clinical Immunology
Volume128
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

Bibliographical note

Funding Information:
Disclosure of potential conflict of interest: W. C. Moore receives research support from the NHLBI Severe Asthma Research Program . E. R. Bleecker receives research support from the National Institutes of Health (NIH)/NHLBI/Severe Asthma Research Program . W. W. Busse is on advisory boards for Centocor and Merck; has consultant arrangements with AstraZeneca, Boehringer Ingelheim, Novartis, TEVA, GlaxoSmithKline, Amgen, Prizer, MedImmune, and Genentech; and receives research support from the NIH-NIAID, NIH-NHLBI, Novartis, AstraZeneca, GlaxoSmithKline, MedImmune, and Ception . M. Castro has consultant arrangements with Electrocore, NKTT, Schering, Asthmatx, and Cephalon; is on the advisory board for Genentech; is a speaker for AstraZeneca, Boerhinger-Ingelheim, Pfizer, Merck, and GlaxoSmithKline; receives research support from Asthmatx, Amgen, Ception, Genentech, MedImmune, Merck, Novartis, the NIH, and GlaxoSmithKline ; and receives royalties from Elsevier . K. F. Chung receives research support from the NIH . S. C. Erzurum receives research support from Asthmatx . R. A. Dweik receives research support from the NIH and the state of Ohio . B. Gaston is a primary shareholder in Respiratory Research, Inc, and receives research support from the NIH . E. Israel has consultant arrangements with Abbott, Amgen, Cowen & Co, GlaxoSmithKline, Icagen, MedImmune, Merck, NewMentor, NKT Therapeutics, Ono Pharmaceuticals US, Pulmatrix, Schering Plough, and Teva Specialty Pharmaceuticals and receives research support from Aerovance, Amgen, Ception Therapeutics, Genentech, Icagen, MedImmune, the NIH, and Novartis . M. L. Mayse has consultant arrangements with Asthmatx. S. P. Peters receives research support from the NIH/NHLBI/Severe Asthma Research Program . N. N. Jarjour has consultant arrangements with Asthmatx and Genentech and receives research support from GlaxoSmithKline, Merck, and MedImmune . The rest of the authors have declared that they have no conflict of interest. Asthma and lower airway disease

Keywords

  • Investigative bronchoscopy
  • exacerbation
  • safety
  • severe asthma

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