Investigative bronchoprovocation and bronchoscopy in airway diseases.
BACKGROUND
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.


OBJECTIVE
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.


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.


CONCLUSIONS
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.
Busse
William W
WW
University of Wisconsin-Madison, USA.
Wanner
Adam
A
Adams
Kenneth
K
Reynolds
Herbert Y
HY
Castro
Mario
M
Chowdhury
Badrul
B
Kraft
Monica
M
Levine
Robert J
RJ
Peters
Stephen P
SP
Sullivan
Eugene J
EJ
D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D001985:Bronchial Provocation Tests; D018893:Bronchoalveolar Lavage; D016085:Bronchoconstrictor Agents; D001999:Bronchoscopy; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000503:physiopathology; D016210:Methacholine Chloride; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride