SAFETY OF FIBEROPTIC BRONCHOSCOPY IN ASTHMATIC AND CONTROL SUBJECTS AND EFFECT ON ASTHMA CONTROL OVER 2 WEEKS

Background - Concerns remain about the safety of bronchoscopy in asthm a and there are few data on the effect of this procedure on asthma con trol in the days or weeks following bronchoscopy. Methods - In an init ial study of bronchoalveolar lavage and bronchial biopsies in asthmati c and control subjects, data on peak expiratory flow rates (PEFR) coll ected prospectively before and after the procedure were available from 21 of the 29 asthmatic subjects studied. These showed a median 23% fa ll in PEFR from baseline after bronchoscopy (range 3-58%). To determin e whether this fall in PEFR following bronchoscopy reflected bronchosp asm or the effect of sedation, PEFR and spirometric tests were perform ed during the two hours following bronchoscopy in a further study of 1 5 symptomatic asthmatic subjects and 20 non-asthmatic controls. To exa mine the effect on asthma control, asthmatic patients recorded PEFR, s ymptom scores, and medication use for two weeks before and after bronc hoscopy. Results - After bronchoscopy with bronchial biopsies there wa s no difference between the median maximal fall in either PEFR or arte rial oxygen saturation between the 15 asthmatic patients (10.4% and 4% , respectively) and 20 controls (12% and 3%). Moreover, there were no significant changes in PEFR, symptom score, or medication use by the a sthmatic subjects in the two weeks after bronchoscopy when compared wi th the two weeks before bronchoscopy. Conclusions - Fibreoptic broncho scopy is well tolerated in asthmatic subjects. Falls in PEFR in both a sthmatic and non-asthmatic subjects after bronchial biopsy may reflect the effects of sedation rather than bronchospasm. Additional bronchoa lveolar lavage may cause bronchoconstriction. Careful monitoring is th erefore essential. Peak flow monitoring up to two weeks after bronchos copy with bronchial biopsy revealed no delayed effects on asthma contr ol.