Influence of Pharyngeal Anaesthesia on Post-Bronchoscopic Coughing: A Prospective, Single Blinded, Multicentre Trial

Background: Local anaesthesia of the pharynx (LAP) was introduced in the era of rigid bronchoscopy (which was initially a conscious procedure under local anaesthetic), and continued into the era of flexible bronchoscopy (FB) in order to facilitate introduction of the FB. LAP reduces cough and gagging reflex, but its post-procedural effect is unclear. This prospective multicentre trial evaluated the effect of LAP on coughing intensity/time and patient comfort after FB, and the feasibility of FB under propofol sedation alone, without LAP. Material and methods: FB was performed in 74 consecutive patients under sedation with propofol, either alone (35 patients, 47.3%) or with additional LAP (39 patients, 52.7%). A primary endpoint of post-procedural coughing duration in the first 10 min after awakening was evaluated. A secondary endpoint was the cough frequency, quality and development of coughing in the same period during the 10 min post-procedure. Finally, the ease of undertaking the FB and the patient’s tolerance and safety were evaluated from the point of view of the investigator, the assistant technician and the patient. Results: We observed a trend to a shorter cumulative coughing time of 48.6 s in the group without LAP compared to 82.8 s in the group receiving LAP within the first 10 min after the procedure, although this difference was not significant (p = 0.24). There was no significant difference in the cough frequency, quality, peri-procedural complication rate, nor patient tolerance or safety. FB, including any additional procedure, could be performed equally well with or without LAP in both groups. Conclusions: Our study suggests that undertaking FB under deep sedation without LAP does to affect post-procedural cough duration and frequency. However, further prospective randomised controlled trials are needed to further support this finding

Diagnostic Yield of Transbronchial Lung Cryobiopsy Compared to Transbronchial Forceps Biopsy in Patients with Sarcoidosis in a Prospective, Randomized, Multicentre Cross-Over Trial

Background: Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). However, in cases with predominantly peribronchial pathology, such as sarcoidosis, TBLF is considered to be diagnostic in most cases. The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis. Methods: In this post hoc analysis of a prospective, randomized, controlled, multicentre study, 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling were included. TBLF and TBLC were both used for each patient in a randomized order. Histological assessment was undertaken on each biopsy and determined whether sarcoid was a consideration. Results: A histological diagnosis of sarcoidosis was established in 17 of 272 cases for which histopathology was available. In 6 out of 17 patients, compatible findings were seen with both TBLC and TBLF. In 10 patients, where the diagnosis of sarcoidosis was confirmed by TBLC, TBLF did not provide a diagnosis. In one patient, TBLF but not TBLC confirmed the diagnosis of sarcoidosis. Conclusions: In this post hoc analysis, the histological diagnosis of sarcoidosis was made significantly more often by TBLC than by TBLF. As in other idiopathic interstitial pneumonias (IIPs), the use of TBLC should be considered when sarcoidosis is suspected

Life-threatening pneumonitis after first-line treatment with osimertinib for primary T790M mutated non-small cell lung cancer

Epithelial growth factor receptor (EGFR) directed tyrosine kinase inhibitor (TKI) treatment is the standard approach in patients with advanced, EGFR-mutated non-small cell lung cancer (NSCLC). Although benefit/risk ratio is favorable for these TKI and side effects are manageable in the vast majority of patients, severe and even life-threatening side effects have been reported. TKI-induced interstitial lung disease (ILD) has been reported for single cases in modest severity, predominantly in EGFR-TKI pretreated patients. Here, we report a case of successful stabilization of a life-threatening ILD in a de novo T790M mutated NSCLC during first-line treatment with osimertinib. As osimertinib will be used more often in many EGFR-positive NSCLC patients in the future, this potentially life-threatening side effect should receive special attention, especially in first-line treatmen

Vergleich von transbronchialer Zangen- und Kryobiopsie bei Patienten mit histologischem Nachweis Sarkoidose-typischer Granulome

Hintergrund Während die transbronchialen Zangenbiopsie (TBLF) in der Diagnostik idiopathischer interstitieller Pneumonien (IIP) aufgrund ihres geringen Wertes nicht empfohlen wird, wird diese Technik bei überwiegend peribronchialer Pathologie, wie z. B. bei der Sarkoidose, als Diagnostikum eingesetzt. Die transbronchiale Kryobiopsie (TBLC) hingegen wird in Leitlinien für die Diagnostik einer vermuteten idiopathischen pulmonalen Fibrose oder exogen allergischen Aveolitis empfohlen. In der vorliegenden Studie wird die diagnostische Wertigkeit der TBLC im Vergleich zur TBLF bei histologischem Nachweis Sarkoidose-typischer Granulome untersucht. Methodik Im Rahmen einer prospektiven, randomisierten, kontrollierten, multizentrischen Studie wurden 359 Patienten mit IIP aufgenommen, bei denen eine bronchoskopische Gewebeentnahme zur Diagnostik indiziert war. Bei jedem Patienten wurde sowohl mittels TBLF als auch TBLC in randomisierter Reihenfolge Gewebe asserviert. In 272 Fällen konnte eine Evaluation durch eine Referenzpathologie erfolgen. Ergebnisse Der histologische Nachweis Sarkoidose-typischer Granulome konnte in 17 von 272 Fällen erbracht werden. Bei 6 von 17 Patienten lieferten beide Techniken die histologische Diagnose einer Sarkoidose, während bei 10 Patienten lediglich die TBLC, nicht jedoch die TBLF diagnostisch war. In einem Fall lieferte die TBLF, nicht aber die TBLC, die Diagnose der Sarkoidose (p<0.05). Nach TBLC traten in insgesamt 10 Fällen periinterventionelle Blutungen auf, nach TBLF in 8 Fällen. Hiervon waren 3 Blutungen nach TBLC mittelschwer bis schwer, jedoch nicht lebensbedrohlich. Schlussfolgerungen In dieser post-hoc Analyse der prospektiven, multizentrischen, randomisierten Studie gelang der Nachweis Sarkoidose-typischer Granulome durch die TBLC signifikant häufiger als durch die TBLF. Wie bei IIP sollte bei Verdacht auf Sarkoidose der Einsatz der TBLC erwogen werden

Diagnostic Yield of Transbronchial Lung Cryobiopsy Compared to Transbronchial Forceps Biopsy in Patients with Sarcoidosis in a Prospective, Randomized, Multicentre Cross-Over Trial

Background: Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). However, in cases with predominantly peribronchial pathology, such as sarcoidosis, TBLF is considered to be diagnostic in most cases. The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis. Methods: In this post hoc analysis of a prospective, randomized, controlled, multicentre study, 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling were included. TBLF and TBLC were both used for each patient in a randomized order. Histological assessment was undertaken on each biopsy and determined whether sarcoid was a consideration. Results: A histological diagnosis of sarcoidosis was established in 17 of 272 cases for which histopathology was available. In 6 out of 17 patients, compatible findings were seen with both TBLC and TBLF. In 10 patients, where the diagnosis of sarcoidosis was confirmed by TBLC, TBLF did not provide a diagnosis. In one patient, TBLF but not TBLC confirmed the diagnosis of sarcoidosis. Conclusions: In this post hoc analysis, the histological diagnosis of sarcoidosis was made significantly more often by TBLC than by TBLF. As in other idiopathic interstitial pneumonias (IIPs), the use of TBLC should be considered when sarcoidosis is suspected