title: Safety of bronchoscopy, biopsy, and BAL in research patients with COPD.
abstract: BACKGROUND
  Bronchoscopy with biopsy and BAL is being performed increasingly in patients with COPD as a research tool. Previous reports have shown these procedures to be safe in asthmatic patients, but there is little safety data specific to COPD.
  
  
  METHODS
  We studied 57 patients with COPD (11 women and 46 men; median FEV(1), 1.2 L [range, 0.64 to 2.69 L]; percent predicted FEV(1), 44.5% [range, 25 to 74.8%]). Eleven patients had mild disease, 28 patients had moderate disease, and 18 patients had severe disease according to British Thoracic Society classification. Ninety-eight bronchoscopies were performed according to American Thoracic Society guidelines: 68 procedures with endobronchial biopsy and BAL and 30 procedures with biopsy alone. Controlled oxygen was administered via nasal cannula, and pulse oximetry and vital signs were monitored.
  
  
  RESULTS
  Five adverse events occurred. One patient in the moderate-disease group had severe bronchospasm requiring 4 days of inpatient treatment. One patient in the severe-disease group had a pneumothorax requiring 7 days of inpatient treatment. There were three episodes of hemoptysis, two with pleuritic pain (in the BAL group) that settled without intervention. No deaths or prolonged morbidity were observed. We found a 2.0% incidence of adverse events requiring hospital treatment and a 3.1% incidence of minor hemoptysis requiring no intervention.
  
  
  CONCLUSIONS
  Bronchoscopy, biopsy, and BAL can be performed safely in patients with COPD, including those with severe disease, provided careful assessment is performed and guidelines are adhered to.
authors.affiliation: Department of Respiratory Medicine, London Chest Hospital, Bonner Road, London, E2 9JX UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Hattotuwa
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Gamble
authors.forename: Terence
authors.initials: T
authors.lastname: O'Shaughnessy
authors.forename: Peter K
authors.initials: PK
authors.lastname: Jeffery
authors.forename: Neil C
authors.initials: NC
authors.lastname: Barnes
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects; D001986:Bronchial Spasm / Q000209:etiology; D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D001999:Bronchoscopy / Q000009:adverse effects*; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010998:Pleurisy / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D012449:Safety