title: Safety of investigative bronchoscopy in the Severe Asthma Research Program.
abstract: BACKGROUND
  Investigative bronchoscopy was performed in a subset of participants in the Severe Asthma Research Program to gain insights into the pathobiology of severe disease. We evaluated the safety aspects of this procedure in this cohort with specific focus on patients with severe asthma.
  
  
  OBJECTIVE
  To evaluate prospectively changes in lung function and the frequency of adverse events related to investigative bronchoscopy.
  
  
  METHODS
  Bronchoscopy was performed by using a common manual of procedures. A subset of very severe asthma was defined by severe airflow obstruction, chronic oral corticosteroid use, and recent asthma exacerbations. Subjects were monitored for changes in lung function and contacted by telephone for 3 days after the procedure.
  
  
  RESULTS
  A total of 436 subjects underwent bronchoscopy (97 normal, 196 not severe, 102 severe, and 41 very severe asthma). Nine subjects were evaluated in hospital settings after bronchoscopy; 7 of these were respiratory-related events. Recent emergency department visits, chronic oral corticosteroid use, and a history of pneumonia were more frequent in subjects who had asthma exacerbations after bronchoscopy. The fall in FEV₁ after bronchoscopy was similar in the severe and milder asthma groups. Prebronchodilator FEV₁ was the strongest predictor of change in FEV₁ after bronchoscopy with larger decreases observed in subjects with better lung function.
  
  
  CONCLUSIONS
  Bronchoscopy in subjects with severe asthma was well tolerated. Asthma exacerbations were rare, and reduction in pulmonary function after the procedure was similar to that in subjects with less severe asthma. With proper precautions, investigative bronchoscopy can be performed safely in severe asthma.
authors.affiliation: Center for Human Genomics and Personalized Medicine Research, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. wmoore@wfubmc.edu
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Moore
authors.forename: Michael D
authors.initials: MD
authors.lastname: Evans
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Bleecker
authors.forename: William W
authors.initials: WW
authors.lastname: Busse
authors.forename: William J
authors.initials: WJ
authors.lastname: Calhoun
authors.forename: Mario
authors.initials: M
authors.lastname: Castro
authors.forename: Kian Fan
authors.initials: KF
authors.lastname: Chung
authors.forename: Serpil C
authors.initials: SC
authors.lastname: Erzurum
authors.forename: Douglas
authors.initials: D
authors.lastname: Curran-Everett
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gaston
authors.forename: Mark
authors.initials: M
authors.lastname: Hew
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.forename: Martin L
authors.initials: ML
authors.lastname: Mayse
authors.forename: Rodolfo M
authors.initials: RM
authors.lastname: Pascual
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Peters
authors.forename: Lori
authors.initials: L
authors.lastname: Silveira
authors.forename: Sally E
authors.initials: SE
authors.lastname: Wenzel
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Jarjour
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D001980:Bronchi / Q000473:pathology / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D055815:Young Adult