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PubMed2005

[Contribution of flexible bronchoscopy to the diagnosis of upper airway alterations].

INTRODUCTION: Flexible bronchoscopy (FB) is becoming an increasingly common diagnostic and therapeutic technique and is currently an essential procedure in pediatric pulmonology departments. Because the procedure is easy to perform under sedation and topical anesthesia, avoiding surgery with general anesthesia, which is required for rigid bronchoscopy, it has allowed the use of airway endoscopy in infants and children to be increased and has reduced patient risks. OBJECTIVE: To analyze the contribution of FB to the diagnosis of upper airway alterations and to characterize the frequency and type of upper airway anomalies. PATIENTS AND METHODS: We retrospectively reviewed the FB performed in our center between January 1993 and March 2003 in children aged less than 14 years old. RESULTS: A total of 456 FB were performed in 378 children. One hundred eleven FB (24.5 % of all endoscopies) were required for suspected upper airway anomalies and 55.8 % corresponded to stridor. Upper airway inspection revealed abnormality in 30.7 % (140 FB). There were no severe complications. CONCLUSION: FB is useful in the diagnosis of upper airway abnormalities. The main indication for FB is stridor and the most common abnormal finding of the upper airway is laryngomalacia.

Adolescent↗
PubMed2006

A prospective analysis of 184 hemoptysis cases: diagnostic impact of chest X-ray, computed tomography, bronchoscopy.

BACKGROUND: The clinical presentation of hemoptysis often raises a number of diagnostic possibilities. OBJECTIVES: This study was designed to evaluate the relative frequency of different causes of hemoptysis and the value of chest radiography, computed tomography (CT) scanning and fiber-optic bronchoscopy in the evaluation of a Greek cohort population. METHODS: We prospectively followed a total of 184 consecutive patients (137 males/47 females, 145 smokers/39 nonsmokers) admitted with hemoptysis between January 2001 and December 2003 to the University Hospital of Heraklion. Follow-up data were collected on August 2005. RESULTS: The main causes of hemoptysis were bronchiectasis (26%), chronic bronchitis (23%), acute bronchitis (15%) and lung cancer (13%). Bronchiectasis was significantly more frequent in nonsmokers (p < 0.02). Among nonsmokers, patients with moderate/severe bleeding or a history of tuberculosis were more likely to have bronchiectasis (OR 8.25; 95% CI 1.9-35.9, p = 0.007 and OR 16.5; 95% CI 1.7-159.1, p = 0.007, respectively). Nonsmokers with normal or abnormal X-rays were equally likely to have bronchiectasis (OR 2.5; 95% CI 0.66-9.39, p = 0.2). Lung cancer was only found in smokers. Smokers with normal X-rays were less likely to have lung cancer compared to smokers with abnormal X-ray (OR 5.4; 95% CI 1.54-19.34, p = 0.004). There were no smokers with normal CT and lung cancer. Follow-up data were collected in 91% of patients. Lung cancer did not develop in any patient assumed to have hemoptysis of another origin than lung cancer on initial evaluation. CONCLUSIONS: Bronchiectasis is the main diagnosis in patients admitted with hemoptysis to a Greek University Hospital and it is more frequent among nonsmokers with moderate/severe bleeding and/or previous tuberculosis infection. Nonsmokers with moderate/severe hemoptysis and/or a history of tuberculosis should be evaluated with high-resolution CT. Smokers with hemoptysis are at increased risk for lung cancer and need to be extensively evaluated with chest CT and bronchoscopy.

Aged↗
PubMed2007

Utility of fiberoptic bronchoscopy for retrieval of aspirated headscarf pins.

BACKGROUND: Headscarf pin aspiration is a common and unique form of foreign body aspiration among young Moslem women. Rigid bronchoscopy (RB) is considered the standard procedure for retrieval. There are little data on the role of flexible fiberoptic bronchoscopy (FOB) in the retrieval of aspirated headscarf pins. OBJECTIVES: The aim of this study is to prospectively evaluate the utility of FOB for the retrieval of aspirated headscarf pins. METHODS: Patients with the diagnosis of headscarf pin aspiration admitted to King Abdullah University Hospital from December 2002 to December 2005 were included in the study. Standard FOB procedure under local anesthesia and conscious sedation was performed as the primary tool for retrieval. RESULTS: A total of 16 cases was admitted during the study period. The mean age was 19 years. The aspirated pin was successfully retrieved in 9/16 cases (56%) during the first attempt of FOB. In another 3 cases, although the pin was successfully retrieved from the bronchial tree, it was lost in the throat and swallowed, and then recovered by esophagogastroduodenoscopy. However, FOB was not successful in 4/16 cases. In 3 cases, the aspirated pins were successfully retrieved by RB under general anesthesia and the fourth case required thoracotomy. CONCLUSIONS: Headscarf pin aspiration is a relatively common form of foreign body aspiration among young Moslem Jordanian women. FOB under local anesthesia can be a useful first-step tool in retrieval, provided facilities for esophagogastroduodenoscopy and RB are readily available.

Adolescent↗
PubMed1976

Cardiopulmonary changes during flexible fiberoptic bronchoscopy.

Changes of pulse rate and arterial blood gases were measured before, during, and after fiberoptic bronchoscopy in eleven patients with resting arterial PO2 breathing room air of 75 mm Hg or greater. Tachycardia was greatest after anesthesia (mean change greater than 20 beats/min) and declined thereafter. Hypoxemia was progressive from the time of entrance of the bronchoscope into the respiratory tree and continued into the immediate postbronchoscopic period when the mean fall was about 16 mm Hg. Mild hyperventilation was noted under all conditions. Since progressive hypoxemia persists following removal of the instrument and does not occur during rigid bronchoscopy, direct irritation causing reflex bronchospasm and the effects of aspirated secretions, anesthetic or lavage must be considered as possible causes for the hypoxemia.

Adult↗
PubMedDate not supplied

Repeat fiberoptic bronchoscopy in patients with recurrent, unexplained hemoptysis.

Repeat fiberoptic bronchoscopy (FB) is indicated in patients with recurrent, unexplained hemoptysis to localize and/or diagnose the source of bleeding. The results of 34 bronchoscopies in 14 patients over a 6-year period were examined. 10 patients had 2 FBs each and 1 patient had 5 procedures at varying intervals. Only early FB detected active bleeding (12/25) early FBs) and localized a bleeding site (10/25). Definitive diagnoses (6/34 FBs) occurred only in patients with lung malignancy and were not necessarily influenced by the timing or frequency of FB. Clinical diagnoses and management were infrequently altered by each FB, except for management of malignancy. Thus, early, repeat FB in this diagnostically difficult group of patients contributes limited immediate information and minimally changes therapy in patients with nonneoplastic conditions. Despite these limitations, direct bronchial visualization by FB remains the most reliable standard available for localizing and, to a lesser extent, diagnosing the etiology of recurrent hemoptysis.

Adult↗
PubMed1987

Relationship between inflammation, alpha-1-acid glycoprotein and lidocaine tolerance during fiber-optic bronchoscopy.

The purpose of this study was to determine the relationship between inflammation, increased alpha-1-acid glycoprotein (AAG), and lidocaine tolerance during fiber-optic bronchoscopy. Previous studies indicate that serum lidocaine levels vary widely from one individual to another. One reason for these variations may be the presence of an ongoing inflammatory process, which enhances serum AAG, a major binding protein of lidocaine. To test this hypothesis, we assayed free and bound lidocaine as well as AAG in the blood of 12 patients after administration of 9 mg/kg of lidocaine during fiber-optic bronchoscopy. Some of the subjects had clear evidence of inflammation or infection. A correlation was found between AAG and total and bound lidocaine but not between AAG and free lidocaine (which remained almost constant). Thus, in spite of the high total levels of lidocaine observed in some patients with inflammatory processes, the free fraction (which is the active and toxic fraction) remained low.

Bronchoscopy↗
PubMed1989

Flexible fiberoptic bronchoscopy does not alter airway responsiveness.

Flexible fiberoptic bronchoscopy (FFB) can induce respiratory mucosal damage. Epithelial damage has been proposed to be of importance in the induction of bronchial hyperresponsiveness. We have examined the influence of FFB on airway responsiveness. Histamine chloride challenge tests were performed in 21 healthy non-smoking volunteers before and after FFB. Since bronchoscopy was performed after pretreatment with atropine and under topical anesthesia with lignocaine, histamine chloride tests were also performed in 6 asthmatics before and after atropine, and in 6 asthmatics before and after local anesthesia with lignocaine. Airway responsiveness was not altered by FFB. Atropine and lignocaine did not have any major influence on airway responsiveness. We suggest that epithelial damage in the central airways induced by FFB is not sufficient to induce bronchial hyperresponsiveness.

Adult↗
PubMed1997

Yield of computed tomography and bronchoscopy for the diagnosis of Mycobacterium avium complex pulmonary disease.

Mycobacterium avium complex (MAC) pulmonary disease with nodules and bronchiectasis is increasing. But the usefulness of computed tomography (CT) and bronchoscopy for diagnosis and the significance of MAC isolation from respiratory secretions are still unclear. For a 4-yr period, we prospectively examined the role of bronchoscopy with bronchial washing and transbronchial lung biopsy in 26 patients who had clusters of small nodules in the periphery of the lung associated with ectatic changes of the draining bronchi on the CT scan. None of them was infected with human immunodeficiency virus. Thirteen of the 26 patients (50%) had cultures positive for MAC, six in the sputum and 13 in the bronchial washing. Epithelioid granuloma was demonstrated in eight of 13 patients with culture-positive MAC and in two of 13 patients in whom MAC was culture-negative. Rapidly growing mycobacteria were cultured in the two patients. Seven of the eight biopsy-positive patients received treatment and responded by sputum conversion and/or radiographic improvement. We found that the CT finding was a useful clue to suspect MAC pulmonary disease and that the bronchial washing was more sensitive than the routine expectorated sputum for MAC isolation. Demonstration of granuloma in more than half of the MAC-positive patients would suggest that MAC may have invaded the lung tissue rather than colonized in the airways.

Adult↗
PubMed2000

Topical lidocaine exaggerates laryngomalacia during flexible bronchoscopy.

In 156 infants and children referred for flexible fiberoptic bronchoscopy (FFB) we examined the larynx before and after application of 2% lidocaine solution to see what effect topical anesthesia might have on laryngeal function. All patients received midazolam and nalbuphine intravenously. Using blinded, randomly re-recorded key segments of the original video recordings of bronchoscopy, we used an empirical scoring system (Table 2) to grade signs of laryngomalacia on a scale of 0 to 8 points before and after application of the lidocaine solution. This score was based on the magnitude of collapse of the arytenoids and folding of the epiglottis during inspiration. Topical lidocaine was more likely to result in an increase in signs of laryngomalacia than in a decrease in such signs (p < 0.0001). Younger patients were more likely to have signs of laryngomalacia before topical anesthesia (odds ratio, 1.83). In a group of 10 additional patients, selected for history and physical findings consistent with laryngomalacia, application of a normal saline solution had no effect on the laryngomalacia score, but application of 2% lidocaine solution to the larynx resulted in a significant increase in this score (p < 0.001). Thus, this study has clearly demonstrated that topical anesthesia in infants and children undergoing FFB exaggerates the findings commonly associated with laryngomalacia. Because overestimation of these findings might lead to unnecessary treatment, it is important to examine the larynx and contiguous structures before applying topical anesthesia.

Administration, Topical↗
PubMed2000

Predictors of pain control in patients undergoing flexible bronchoscopy.

The purpose of this study was to assess the extent to which patients undergoing flexible bronchoscopy (FOB) experience pain and to identify patient factors and process of care factors that are associated with pain. We conducted a prospective cohort study on 481 patients undergoing FOB. Overall control of pain during FOB was the primary outcome. The mean age of the patients was 48 yr, 50% were male, and 32% required supplemental oxygen prior to FOB. Pain control was excellent in 36% of patients, but 10% considered it to be fair or poor. Patient factors associated with excellent pain control were excellent health (versus poor health, OR = 6.25 [95% CI, 2.28-16.67]), more education (college education versus high school education, OR = 1.72 [95% CI, 1.05-2.86]), and not having asthma (OR = 2.86 [95% CI, 1.09-7.14]). Process of care factors associated with excellent pain control were not being bothered by scope insertion (versus bothered, OR = 3.65 [95% CI, 1.99-6.98]), no memory of FOB (versus some memory, OR = 2.33 [95% CI, 1.24-4.44]), and higher ratings of information about the procedure (per 1-point increase on a 12-point scale, OR = 1.57 [95% CI, 1.41-1.78]). This is the first large-scale, prospective study to evaluate patient and process of care factors that influence pain control during FOB. It demonstrated that there are patient characteristics and process of care factors that need to be considered when evaluating pain during bronchoscopy. Improved preparation of patients with lower education, inferior health status, and asthma may lead to decreased pain during FOB. Bronchoscopists may be able to reduce pain during FOB by identifying methods to decrease pain on scope insertion, by improving the information provided to patients, and by achieving greater levels of amnesia during FOB.

Adolescent↗
PubMed2000

Functional approach to infants and young children with noisy breathing: validation of pneumotachography by blinded comparison with bronchoscopy.

Flow-volume loop evaluation yields considerable diagnostic information about adult patients with upper airway obstruction. No conclusive data support the reliability of this method in young children with noisy breathing. We used analysis of flow-volume loops at tidal breathing (TB-FV) as a first diagnostic approach to young children presenting with persistent noisy breathing (chronic stridor and/or wheezing). Flexible fiberoptic bronchoscopy was performed to establish a conclusive diagnosis and was used to verify the accuracy of the preliminary functional localization of the airway obstruction causing noisy breathing. The physician conducting pneumotachography was blinded to the bronchoscopic findings in the study, and the investigators conducting bronchoscopy were blinded to the pneumotachographic findings. Through a 6-yr period, 113 consecutive young children (ranging in age from 15 to 48 mo) with noisy breathing were enrolled in the study. Three morphologically abnormal TB-FV patterns, as compared with the normal round-shaped TB-FV loops obtained with 15 healthy children, were identified in 110 patients. A TB-FV pattern of inspiratory fluttering was found in 26 subjects and in the first 3 yr of the study was always associated with an endoscopic diagnosis of isolated laryngomalacia. Subsequently, this pattern was used to diagnose isolated laryngomalacia in 18 other infants, in whom endoscopy was avoided. Of infants with endoscopic evidence of airway obstruction ranging from the glottis to the mainstem bronchi (49 subjects), all but three showed a TB-FV loop pattern characterized by expiratory-limb flattening. A concave expiratory loop, with early expiratory peak flow and low flow at low volume, was invariably associated with peripheral bronchoconstriction, without endoscopic evidence of anatomic abnormalities (20 cases). In conclusion, TB- FV loop analysis is a noninvasive, accurate method of establishing the site of airway obstruction in young children with recurrent stridor and/or wheezing. Clinical use of this method may provide interesting pathophysiologic information and may be useful in addressing the diagnostic management of such children.

Airway Obstruction↗
PubMed2000

Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis: experience at an acquired immune deficiency syndrome reference center in Rio de Janeiro, Brazil.

Many patients with suspected pulmonary tuberculosis (PTB) do not produce sputum spontaneously or are smear-negative for acid-fast bacilli (AFB). We prospectively compared the yield of sputum induction (SI) and fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) for the diagnosis of PTB in a region with a high prevalence of tuberculosis and human immunodeficiency virus (HIV) infection. Fifty seven percent (143 of 251) of patients had diagnoses of PTB, of whom 17% (25 of 143) were HIV seropositive. There were no significant differences in the yields of AFB smears or cultures whether obtained via SI or BAL. Among 207 HIV-seronegative patients, the AFB smear and mycobacterial culture results from specimens obtained by SI and BAL were in agreement in 97% (202 of 207) (kappa test = 0.92) and 90% (186 of 207) (kappa test = 0.78), respectively. Among HIV-seropositive patients the agreements between AFB smear and culture results for SI and BAL specimens were 98% (43 of 44) (kappa test = 0.93) and 86% (38 of 44) (kappa test = 0.69), respectively. We conclude that SI is a safe procedure with a high diagnostic yield and high agreement with the results of fiberoptic bronchoscopy for the diagnosis of PTB in both HIV-seronegative and HIV-seropositive patients.

AIDS-Related Opportunistic Infections↗
PubMed1975

Bacteremia related to fiberoptic bronchoscopy. A case report.

This is the first reported case of fiberoptic bronchoscopy associated with bacteremia originating in the respiratory tract. The patient had a gram-negative bacterial bronchitis before fiberoptic bronchoscopy and later died of complications of the bacteremia.

Aged↗
PubMed1976

Should fiberoptic bronchoscopy aspirates be cultured?

The reliability of fiberoptic bronchoscopy as a method to study the bacteriology of the lower respiratory tract was tested. The procedure used was suction aspiration through the inner channel after topical anesthesia with lidocaine. To detect contamination by oropharyngeal bacteria, the aspirates were cultured in patients with no evidence of active infection, comparison was made with results of transtracheal aspiration cultures, and the aspirate was tested for the presence of an oral dye marker. Results with all 3 methods of analysis indicated contamination with oropharyngeal bacteria that were presumably introduced during instrumentation through the upper airways. An additional factor studied was the effect of topical anesthetics. Analysis of aspirates showed that as much as 96 per cent of the specimen was anesthetic solution. Lidocaine also proved toxic to lower respiratory tract pathogens, although there were significant differences between bacterial species. It was concluded that fiberoptic bronchoscopy as performed in this study does not reliably reflect the bacteriology of the lower respiratory tract.

Anti-Bacterial Agents↗
PubMed1979

A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture.

Seven types of brush catheter were studied in vitro to determine the optimal catheter design for obtaining specimens for bacterial culture using fiberoptic bronchoscopy. The various catheters were inserted through the inner channel, which was contaminated with fresh saliva. The specimen was then obtained by inserting the brush into a broth culture of a marker organism at the distal end of the bronchoscope. Relative merits were based on quantitative bacterial counts of salivary "contaminants" and the marker organism. The catheter that proved superior had telescoping cannulas with a distal occlusion. Twenty-six samplings using catheters with this design uniformly showed no contaminants and high counts of the marker organism. The catheter with telescoping cannulas and a distal occlusion composed of polyethlene glycol was then tested with bronchoscopy performed on 8 healthy volunteers and 6 patients with clinical evidence of a lower airway infection. The specimens yielded likely pulmonary pathogens in high concentrations from patients with pneumonia or lung abscess. Possible contaminants were recovered in low concentrations from 2 of 14 subjects. These in vitro studies and the preliminary clinical trial support the use of this type of catheter for obtaining bronchoscopic specimens for bacterial culture.

Bacteria↗
PubMed1980

Bronchoscopy and lung lavage induced bilateral pulmonary neutrophil influx and blood leukocytosis in dogs and monkeys.

Investigators have previously determined that repetitive lung washes attract neutrophils to the lungs. They ascribed this attraction to the release of chemotactic factors. Our studies demonstrate that lavage of one lobe of a lung attracts neutrophhils to unwashed lobes as well; therefore, the attraction of neutrophils cannot be entirely due to the local release of chemotactic agents. Further experiments showed that influx of neutrophils also occurred after bronchoscopy without lung lavage but not after the anesthesia alone. These studies suggest that the lungs have mechanisms that regulate and control neutrophil influx both locally and contralaterally. It is not yet clear whether the controlling mechanisms represent an integrated system in the control of leukocyte traffic through the lungs. In addition, lung lavage and bronchoscopy without lung lavage cause an increase in the blood leukocyte count, with an increase in the number of young neutrophil forms. Lung wash concentrates cause a dramatic increase in the number of blood leukocytes when instilled into a bronchus. These data indicate that lungs contain a material that can stimulate the bone marrow to release leukocytes from its reserves.

Anesthesia↗
PubMed1982

Chronic cough: bronchoscopy or pulmonary function testing?

To determine how frequently bronchoscopic examination and pulmonary function testing are useful in establishing a diagnosis in patients with chronic cough as an isolated clinical symptom, we reviewed the records of all patients referred to pulmonary specialists at 3 community hospitals for evaluation of cough over a 6-yr period. There were 109 patients with the isolated symptom of chronic cough and a normal or stable chest roentgenogram. Bronchoscopy was performed in 51. All patients but 1 were followed until the cough disappeared or for a minimum of 1 yr. Carcinoma was established as the cause for cough in 1 patient. Spirometry and/or bronchial inhalation challenge was performed in 87 patients. Previously undiagnosed asthma was discovered in 39 patients by these means. Pulmonary function testing has diagnostic value in this population, but bronchoscopy is of limited value in determining the cause of isolated chronic cough.

Adolescent↗
PubMed1984

Correlation between serial pulmonary function tests and fiberoptic bronchoscopy in patients with Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome.

The records of 9 adult male patients with the acquired immune deficiency syndrome (AIDS) and biopsy-proved Pneumocystis carinii pneumonia were reviewed to determine the correlation between serial pulmonary function tests and the presence or absence of Pneumocystis organisms in subsequent bronchoscopy specimens. At diagnosis, total lung capacity (TLC) or vital capacity (VC) was abnormally low in 4 patients (44%) and diffusing capacity (DLCO) was abnormally low in 8 patients (89%). The ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) was elevated in all patients. After 21 to 47 days of specific therapy for Pneumocystis pneumonia, changes in DLCO, TLC, VC, and FEV1/FVC did not correlate with the presence or absence of Pneumocystis organisms in bronchoscopy specimens from 7 patients. However, changes in DLCO 105 to 258 days after diagnosis seemed to correlate with the late response to treatment in 6 patients. These results suggest that decisions to terminate specific therapy for Pneumocystis pneumonia in patients with AIDS should not be based on short-term changes in pulmonary function.

Acquired Immunodeficiency Syndrome↗