THE BRONCHITIS INDEX - A SEMIQUANTITATIVE VISUAL SCALE FOR THE ASSESSMENT OF AIRWAYS INFLAMMATION

Flexible fiberoptic bronchoscopy has been proven to be an effective to ol for the assessment and characterization of airway inflammation. Vis ual inspection of airways affected by chronic bronchitis discloses an abnormal appearance characterized by erythema, edema, secretions, and friability. It was hypothesized that the visual appearance of airway i nflammation could be assessed in a semiquantitative manner. A bronchit is index (BI) was developed that scores the visual appearance of airwa ys according to the presence or absence of abnormal edema, erythema, s ecretions, and friability (0 = normal, 3 = remarkably abnormal). The B I was determined in three study groups: 86 subjects with chronic bronc hitis, 15 subjects who smoked cigarettes, but did not have chronic bro nchitis, and 25 normal, nonsmoking control subjects. The reproducibili ty of the BI was determined by comparing the results from pairs of two independent observers assessing 249 subjects undergoing fiberoptic br onchoscopy under various investigative protocols. In total, nine inves tigators scored the airways. For the three observer pairs with more th an six observations, there were no differences noted in the BI (p = 0. 43, 0.67, 0.82). To control for the effect of cough upon the BI, lidoc aine usage was recorded. No correlation was found between lidocaine us age and BI. As previously noted for a smaller group of subjects, the B I was found to be elevated in those with chronic bronchitis (13.2 +/- 0.53) compared with both asymptomatic smokers (8.5 +/- 0.89, p<0.0005) and normal volunteers (2.3 +/- 0.55, p<0.0001); the latter two groups also differed significantly (p<0.0001). The BI was also found to corr elate significantly with bronchial sample lavage fluid neutrophil cont ent in lavage fluid obtained after determination of the BI and with ci garette smoking as quantitated by pack years. Conversely, the BI corre lated negatively with the spirometric measures of airway obstruction, FEV1, FEV1/FVC, FEV25-75, and FEFmax. Thus, the BI appears to be a rep roducible, semiquantitative assessment of the visual appearance of air way inflammation. It may be a useful bronchoscopic adjunct for the ass essment of airway inflammation in clinical investigations.