title: Survey of academic pulmonologists, oncologists, and infectious disease physicians on the role of bronchoscopy in managing hematopoietic stem cell transplantation patients with pulmonary infiltrates.
abstract: BACKGROUND
  In the absence of evidence-based guidelines, there is potential for variability in the management of hematopoietic stem cell transplantation (HSCT) patients with pulmonary infiltrates. We decided to perform a nationwide survey of pulmonologists, oncologists, and infectious disease physicians on the role of bronchoscopy in managing HSCT patients.
  
  
  METHODS
  An 18-question survey was prepared, and after being internally reviewed it was sent through electronic mail to all hematology oncology, pulmonary and critical care, and infectious disease fellowship programs in the United States. Both faculty and fellows from all training programs were asked to electronically fill out the survey.
  
  
  RESULTS
  A total of 167 responses, representing 76 different institutions were collected (62 pulmonary, 49 oncology, 53 infectious disease). Pulmonologists felt that bronchoscopy was less likely to yield a positive result or change pharmacological therapy (P-value=0.02 and 0.02). With regard to timing for bronchoscopy in HSCT recipients, there was consensus between all the 3 groups that patients who are non-neutropenic and do not have cavitating infiltrates on chest computed tomography scan should receive bronchoscopy only after failure of empiric antimicrobial therapy. However, there was no agreement between the 3 groups on when neutropenic patients or those with cavitating lesions should receive bronchoscopy.
  
  
  CONCLUSIONS
  In the absence of randomized clinical trials and evidence-based guidelines, disparities exist in the use of bronchoscopy in the management of infiltrates. These differences were observed within and between both specialties. This study reflects the need for further research to better define the role of bronchoscopy in these patients.
authors.affiliation: *Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital, Johar Town, Lahore, Pakistan †Wake Forest University Baptist Medical Center, Winston Salem, NC.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Wahla
authors.forename: Arjun
authors.initials: A
authors.lastname: Chatterjee
authors.forename: Irtaza I
authors.initials: II
authors.lastname: Khan
authors.forename: John F
authors.initials: JF
authors.lastname: Conforti
authors.forename: Edward
authors.initials: E
authors.lastname: Haponik
mesh_terms: D001291:Attitude of Health Personnel; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D055552:Infectious Disease Medicine; D008495:Medical Oncology; D011014:Pneumonia / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D015272:Pulmonary Medicine; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents