Bronchial Responsiveness Is Not Increased by Bronchoalveolar and Bronchial Lavage Performed after Allergen Challenge

Gianiorio, Piero; Bonavia, Marco; Crimi, Emanuele; Lantero, Sabina; Crimi, Paolo; Rossi, Giovanni A.; Brusasco, Vito

doi:10.1164/ajrccm/143.1.105

Cited by 16 publications

(8 citation statements)

References 5 publications

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“…This is consistent with previous studies. GIANORIO et al [22] showed that BAL performed either 4 or 24 h postallergen challenge neither deteriorated lung function nor increased airway responsiveness in a group of atopic patients with a history of rhinitis and/or bronchial asthma.…”

Section: Discussionmentioning

confidence: 98%

Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma: Table 1—

Elston

Whittaker²,

Khan³

et al. 2004

Eur Respir J

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Bronchoscopy with endobronchial biopsy (EBB) and/or bronchoalveolar lavage (BAL) has become an important research tool in asthma. A recent report has suggested audit and reporting of the safety of these procedures.A total of 159 asthmatic patients (84 males, 75 females), aged 18-52 (median 27) yrs, forced expiratory volume in one second 53-120 (median 88) % predicted, underwent 273 bronchoscopies in six clinical research studies. On 228 occasions, EBB and BAL were performed and, on 45 occasions, EBB was performed alone. On 48 occasions, bronchoscopy was performed 24 h post-allergen challenge.Adverse events occurred on 34 out of 273 occasions, none of which were following allergen challenge. Post-EBB and BAL, four patients developed pleuritic chest pain, shortness of breath and fever. A further two patients experienced pleuritic chest pain alone post-EBB/BAL. Bronchospasm or worsening of asthma symptoms occurred on 14 occasions, 13 post-EBB/BAL and on one occasion post-EBB alone. Fever/flu-like symptoms were reported on nine occasions following EBB and BAL. One subject had haemoptysis post-EBB/BAL, but required no intervention.In conclusion, bronchoscopy, endobronchial biopsy and bronchoalveolar lavage can be performed safely in asthmatic patients. Most of the complications were seen where bronchoalveolar lavage and endobronchial biopsy were both performed, suggesting that bronchoalveolar lavage accounts for most of the adverse events. Fibreoptic bronchoscopy with endobronchial biopsy (EBB) or bronchoalveolar lavage (BAL) has become an important tool in asthma research over the last two decades. These techniques have led to significant advances in the understanding of the pathogenesis of asthma and, in particular, the role of inflammatory cells and mediators [1][2][3][4]. In addition, intervention studies with new and existing treatments have provided useful insight into the mechanisms of action and efficacy of these treatments [5][6][7]. Following initial concerns over the safety of these techniques in asthmatic patients [8,9], consensus guidelines were published by the National Heart, Lung and Blood Institute [10,11]. More recently, three papers have reported bronchoscopy to be safe and well-tolerated in a relatively small number of asthmatic patients [12][13][14]. Despite this, concerns still remain and a recent report has suggested audit and continued reporting of the safety of these procedures. The current authors report their experience of adverse events related to fibreoptic bronchoscopy performed in asthmatic subjects taking part in six clinical research studies. Methods Study subjectsA total of 159 patients with asthma (84 males, 75 females), forced expiratory volume in one second (FEV1) 53-120 (median 88) % predicted, aged 18-52 (median 27) yrs were recruited for six studies and underwent a total of 273 bronchoscopies. On 228 occasions, subjects underwent EBB and BAL, 48 of which were performed 24 h post-allergen challenge. On 45 occasions, subjects had EBB alone. Subjects were recruited from ...

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Section: Discussionmentioning

confidence: 98%

Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma: Table 1—

Elston

Whittaker²,

Khan³

et al. 2004

Eur Respir J

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“…The first group of 10 patients (all males, ages 15-27 years) underwent fiberoptic bronchoscopy and BAL at baseline conditions (baseline group, patients 1-10), while a second group of 12 patients (10 males and 2 females, ages 21-42 years) underwent bronchoscopy 4-6 h after allergen inhalation challenge (challenged group; patients [11][12][13][14][15][16][17][18][19][20][21][22] (Table 1). Asthma was defined according to the criteria of the American Thoracic Society [22,35], all the patients having a reversible airway obstruction characterized by a >20% increase in forced expiratory volume in 1 s (FEV 1 ) after inhalation of 200 g of salbutamol and/or a positive inhalation challenge with MCh.…”

Section: Study Populationmentioning

confidence: 99%

“…The dose of MCh was twofold-incremented until FEV 1 was decreased below 80% of control (inhalation of saline) or up to a maximal dose of 5 mg. The dose causing a 20% fall of FEV 1 (Pd 20 ) was calculated by interpolation of the dose-response curves, as described previously [20,30].…”

Section: Bronchial Challenge With Mch or Allergensmentioning

confidence: 99%

Airway Eosinophilic Inflammation and Bronchial Hyperresponsiveness after Allergen Inhalation Challenge in Asthma

Oddera

Silvestri

Penna³

et al. 1998

Lung

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Allergen exposure in atopic asthmatic patients is associated with recruitment and activation of eosinophils in the airways. Once activated, eosinophils release toxic products, including the eosinophil cationic protein (ECP), able to damage bronchial structures and to increase bronchial hyperresponsiveness. With this background, the present study was designed to evaluate whether ECP levels in bronchoalveolar lavage (BAL) fluid could reflect, better than BAL eosinophil counts, the cellular activation that follows allergen exposure in atopic asthmatics. Twenty-two atopic patients attended the laboratory on two separate days. On the 1st day, they underwent methacholine (MCh) inhalation challenge to detect the degree of nonspecific bronchial hyperresponsiveness. On the 2nd day, they underwent fiberoptic bronchoscopy and BAL, at baseline or 4-6 h after allergen inhalation challenge. In this latter patient group, MCh challenge was repeated 3-5 h after allergen challenge, 1 h before fiberoptic bronchoscopy. The analysis of the mean baseline FEV1 values and the degree of bronchial reactivity to MCh (MCh Pd20) on the 1st study day did not demonstrate differences between the two patient groups (p > 0.1, each comparison). In addition, in the allergen-challenged group, MCh Pd20 was decreased significantly after allergen challenge (151.4 micrograms/ml and 67.6 micrograms/ml, respectively, before and after challenge; p < 0.05). Evaluation of the different BAL cell types demonstrated that the proportions of eosinophils and epithelial cells were increased significantly in the allergen-challenged group compared with the group evaluated at baseline (p < 0.01 and p < 0.05, respectively). Moreover, ECP levels, corrected by the correspondent albumin levels (ECP/Alb), were higher in the allergen-challenged group compared with the group evaluated at baseline (p < 0.05). In addition, although a positive correlation was demonstrated between BAL eosinophil percentages and ECP/Alb values (r = 0.72, p < 0.05) in the group evaluated at baseline, no links were found between these parameters in the allergen-challenged group (p > 0.1). However, in this latter group, a weak positive correlation was demonstrated between eosinophil percentages and delta Mch, i.e., the increased non-specific bronchial reactivity, which is observed after allergen challenge (r = 0.55; p < 0.05). Thus, in stable asthmatic patients an ongoing activation of eosinophils parallels their migration, but this eosinophilic inflammation is not strictly related to bronchial reactivity to Mch. By contrast, after allergen inhalation challenge, eosinophil recruitment and activation seem to follow different temporal kinetics, and eosinophilic inflammation may be partially associated with the degree of airway hyperresponsiveness.

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“…Jarjour and colleagues (77) reported no significant difference in lung function measured 2 hours after a segmental allergen challenge in subjects with asthma as compared with subjects with allergic rhinitis. When BAL and biopsy were performed after whole lung allergen challenge, no further change in AHR was documented (78). Thus, the experience to date suggests that these challenge procedures are well tolerated.…”

Section: Safetymentioning

confidence: 99%

“…This is also generally well tolerated, although changes in lung function have been reported (76). BAL does not significantly alter airway responsiveness, airflow limitation, and/or airway inflammation when BAL is incorporated into other procedures, such as bronchial biopsy, and segmental or whole lung allergen challenge (71,(76)(77)(78)80). Nonetheless, cough, wheezing, and post-bronchoscopy fever have been associated with BAL.…”

Section: Safetymentioning

confidence: 99%

Investigative Bronchoprovocation and Bronchoscopy in Airway Diseases

Busse

Wanner

Adams

et al. 2005

Am J Respir Crit Care Med

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Rationale: Basic and clinical research strategies used for many lung diseases have depended on volunteer subjects undergoing bronchoscopy to establish access to the airways to collect biological specimens and tissue, perhaps with added bronchoprovocation in asthma syndromes. These procedures have yielded a wealth of important scientific information. Since the last critical review more than a decade ago, some of the techniques and applications have changed, and untoward events have occurred, raising safety concerns and increasing institutional review scrutiny. Objectives and Methods: To reappraise these investigational methods in the context of current knowledge, the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health convened a working group to review these procedures used for airway disease research, emphasizing asthma and chronic obstructive pulmonary disease. Main Results: The group reaffirmed the scientific importance of investigative bronchoscopy and bronchoprovocation, even as less invasive technologies evolve. The group also considered the safety of bronchoscopy and bronchoprovocation with methacholine and antigen to be acceptable for volunteer subjects and patients, but stressed the need to monitor this closely and to emphasize proper training of participating medical research personnel. Issues were raised about vulnerable volunteers, especially children who need surrogates for informed consent. Conclusion: This review of investigative bronchoscopy and bronchoprovocation could serve as the basis for future guidelines for the use of these procedures in the United States.

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Bronchial Responsiveness Is Not Increased by Bronchoalveolar and Bronchial Lavage Performed after Allergen Challenge

Cited by 16 publications

References 5 publications

Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma: Table 1—

Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma: Table 1—

Airway Eosinophilic Inflammation and Bronchial Hyperresponsiveness after Allergen Inhalation Challenge in Asthma

Investigative Bronchoprovocation and Bronchoscopy in Airway Diseases

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