Pneumologie 2015; 69 - P25
DOI: 10.1055/s-0035-1551927

Flexible bronchoscopy in COPD: a prospective, case-control study

P Grendelmeier 1, M Tamm 1, K Jahn 1, E Pflimlin 1, D Stolz 1
  • 1University Hospital Basel, Switzerland

Introduction: Flexible bronchoscopy is increasingly used for diagnostic and therapeutic purposes in patients with COPD. However, the safety of this examination in this patient group has not been extensively evaluated. We aimed to compare the incidence of adverse events and complications between patients with and without COPD undergoing bronchoscopy. In addition, the development of subclinical respiratory compromise and patient-reported outcomes (PRO) were evaluated.

Methods: Prospective, controlled, case-control study including 1400 consecutive patients undergoing diagnostic or therapeutic bronchoscopy at a tertiary care center. Patients were classified as COPD or non-COPD according to lung function performed within 72 hours prior to bronchoscopy. Respiratory compromise was assessed by transcutaneous capnography.

Results: Main indications for bronchoscopy were suspicion of infection (35.9%) and bronchus carcinoma (22.0%). Most frequent procedures included BAL (67.5%), endobronchial Bx (15.4%) and TBB (14.7%). Complexe interventions including EBUS, stent-placement, laser and bronchoscopy lung volume reduction procedures were performed in 202 cases. Patients with COPD (n = 440) were significantly older (66.5 ± 10.2 yo), had poorer lung function (Post-BD FEV1%pred 56.9%± 24.4; DLCO 57.4%± 22.7), higher ASA-scores, more comorbidities and co-medication. At baseline, pO2 was lower and pCO2 higher than non-COPD patients. Patients with COPD required lower propofol dosis pro kg/min (p = 0.002) and a longer examination (p < 0.0001). Overall, the incidence of complications (Chin support, artificial airway, intubation, bleeding, pneumothorax, need for abortion or ICU, death) were similar in both groups. Individually, only placement of an artificial airway more commonly required in COPD patients (11.7% vs. 7.4%, p = 0.021). This difference was no longer significant after adjustment for the duration of bronchoscopy. Patients with COPD had a longer time with SO2< 88% (1.16 min [0.07 – 5.105] vs. 0.16 min [0 – 1.44], p = 0.001) and a lower lowest SO2 (85% [83 – 90] vs. 87% [80 – 88], p = 0.004) during examination. Patients with and without COPD presented different hemodynamic responses to sedation but a similar increase in paCO2 as assessed by capnography. There were no differences in PROs. In total, 98.5% of patients with COPD would undergo another bronchoscopy if indicated.

Conclusion: Flexible bronchoscopy in patients with COPD is safe.