Safety of research bronchoscopy in mild-moderate and severe asthma

SUMMARY. OBJECTIVES: Fiberoptic bronchoscopy (FB) as a research tool has contributed considerably to the understanding of the pathogenesis of asthma, but there are concerns regarding its safety, especially in patients with severe asthma. The aim of this study was to document safety data on FB and sampling techniques in asthma research. METHODS: A total of 75 subjects (36 mild-moderate asthmatics, 25 severe asthmatics and 14 healthy control subjects), participating in three studies, underwent research FB. Depending on the study, endobronchial and nasal biopsy, bronchioalveolar lavage (BAL) and bronchial brushing were performed, according to established guidelines. Pulmonary function tests were performed prior to bronchoscopy and 2 hours after the procedure. Daily peak expiratory flow (PEF) measurements were recorded 5 days before and 5 days after bronchoscopy in the 30 patients participating in the first two studies. RESULTS: FB was tolerated well. None of the patients or healthy control subjects developed severe adverse reactions during or after bronchoscopy. Only two patients with severe asthma presented mild adverse events; one demonstrated immediate and complete occlusion of the middle lobe segmental bronchial lumen after BAL instillation and another developed mild desaturation (SaO2 91%). There were no significant changes in FEV1 and PEF measurements after bronchoscopy. CONCLUSIONS: Research FB can be performed safely in patients with asthma, including those with severe disease, with careful assessment and adherence to guidelines. Pneumon 2010, 23(1):34-47

Preoperative evaluation of the respiratory system: A narrative review based on Hellenic Thoracic Society guidelines

Preoperative evaluation prior to thoracic surgery aims to assess the risk associated with the planned surgical intervention and thus to aid the selection of the appropriate plan of anaesthesia and of perioperative care that will provide optimal patient safety. Risk factors for the occurrence of perioperative and postoperative complications can be classified as patient-related and procedure-related. Among others, they include age, increased body weight, the presence of comorbidities such as chronic respiratory diseases, smoking history, site of surgery, duration of anaesthesia, and the type of anaesthesia. The preoperative evaluation is predominantly based on obtaining a detailed medical history and performance of a comprehensive physical examination. Preoperative chest radiograph and exercise testing are indicated in some highrisk patient groups, while assessment of oxygenation, pulmonary function, and laboratory parameters (such as albumin, urea nitrogen, and haemoglobin) are important factors for determining the risk of postoperative respiratory complications for all patients. This article outlines disease-specific evaluation and management practices for patients with chronic obstructive pulmonary disease, asthma, obstructive sleep apnoea, pulmonary hypertension, right-sided heart failure, lung cancer and interstitial lung disease that are about to undergo thoracic surgery