The clinical yield of bronchoscopy in the management of cystic fibrosis: A retrospective multicenter study

Abstract

Background: Pulmonary disease is the leading cause of morbidity and mortality in people with cystic fibrosis (pwCF). Several studies have shown no benefit for bronchoscopy and bronchoalveolar lavage (BAL) over sputum to obtain microbiological cultures, hence the role of bronchoscopy in pwCF is unclear.Aim: To analyze how bronchoscopy results affected clinical decision-making in pwCF and assess safety.Methods: A retrospective analysis of all charts of pwCF from three CF centers in Israel, between the years 2008 and 2019. We collected BAL culture results as well as sputum cultures obtained within 1 month of the BAL sample. A meaningful yield was defined as a decision to start antibiotics, change the antibiotic regimen, hospitalize the patient for treatment, or the resolution of the problem that led to bronchoscopy (e.g., atelectasis or hemoptysis).Results: During the study years, of the 428 consecutive patient charts screened, 72 patients had 154 bronchoscopies (2.14 bronchoscopies/patient). Forty-five percent of the bronchoscopies had a meaningful clinical yield. The finding of copious sputum on bronchoscopy was strongly associated with a change in treatment (OR: 5.25, 95% CI: 2.1−13.07, p < 0.001). BAL culture results were strongly associated with a meaningful yield, specifically isolation of Aspergillus spp. (p = 0.003), Haemophilus influenza (p = 0.001). Eight minor adverse events following bronchoscopy were recorded.

Detection of pathogenic bacteria and biomarkers in lung specimens from cystic fibrosis patients

“…Other methods to obtain specimens from the CF lung such as sputum, broncho-alveolar lavage, and exhaled breath specimens have also been described [9][10][11][12][13]. The advantages of the PneumoniaCheck Tm device for collecting lung specimens is that it is non-invasive, easy for most patients to use, amenable to use in the home, and of low cost.…”

“…Oropharyngeal swabs specimens can be obtained but do not offer information on inflammation or pathogens in the lung, and have not been validated for use in managing adult CF patients [8]. A variety of other methods to get lung specimens have been used including bronchiolar alveolar lavage but it is invasive, not available in all settings, costly, and includes increased risk to the patient compared to non-invasive methods [9,10]. Exhaled breath specimens, including a recently described device that passes exhaled breath through water, have also been used to obtain specimens from the lung [11][12][13] In this study, we report a proof of principle study of a device (PneumoniaCheck TM ) that captures coughed droplets from the lung [14][15][16], to detect both bacterial pathogens and biomarkers from the lung.…”