Chest
Volume 85, Issue 6, June 1984, Pages 723-728
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Bronchoalveolar Lavage: Its Safety in Subjects with Mild Asthma

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It has been suggested that fiberoptic bronchoscopy may induce life-threatening bronchospasm in persons with asthma. The safety of bronchoscopy and bronchoalveolar lavage (BAL) with bilateral installation of 300 ml of saline solution was assessed prospectively in ten adults with mild asthma as a part of a study of the lower respiratory tract in bronchospastic disease. Asthmatic subjects had pretreatment with intravenous aminophylline prior to bronchoscopy. Pulmonary function tests were performed prior to and immediately after the procedure, and values were compared to results in 12 normal adults undergoing bronchoscopy with BAL. One subject had mild bronchospasm (the third subject) before BAL could be performed. There were no major complications in the remaining asthmatic or normal subjects. Mean forced expiratory volume in one second (FEV1) did not change significantly in either group, and the mid-flow rate at 50 percent of vital capacity ( V. max50%) decreased significantly only in normal subjects (p = 0.002). Moreover, none of the nine asthmatic subjects completing bronchoscopy with BAL had clinically significant bronchospasm. These results suggest that elective fiberoptic bronchoscopy and BAL can be performed safely in subjects with mild asthma.

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Normal Control Subjects

Twelve normal healthy volunteers from the New Haven area served as controls. Their mean± SD age was 25.0±5.2 years, and there were 11 males and 1 female. None smoked cigarettes or had experienced an acute illness in the four weeks prior to study. Chest roentgenograms were normal in all subjects prior to BAL. All denied any history of respiratory disease, including asthma.

Asthmatic Subjects

Ten persons (five males and five females) were studied. Their mean age was 27.1 ± 3.5 years; one currently smoked cigarettes.

RESULTS

Demographic details for all study subjects are shown in Table 1. There were no significant differences between groups with regard to sex, age, or number of subjects who smoked cigarettes. Asthmatic subjects underwent BAL with a similar amount of saline solution as normal subjects (315.6±19.2 ml vs 310±10.2 ml), and the percentage of lavage fluid recovered from both groups did not differ significantly (64.8 ±8.2 percent vs 71.5 ± 7.2 percent, respectively). Theophylline blood levels were within

DISCUSSION

The results of this study indicate that fiberoptic bronchoscopy with BAL can be performed with safety in patients with mild asthma. One of ten subjects did not have BAL performed because of bronchoscopically induced but mild bronchospasm which responded immediately to an inhaled bronchodilator drug. All other subjects had minor signs and symptoms related to bronchoscopy with BAL, but these findings were not different from those experienced by normal subjects.

We specifically chose for our study

ACKNOWLEDGMENT

The authors thank Jacob Loke, M.D., for his assistance with pulmonary function testing, Herbert Reynolds, M.D., for his advice and critical review of the manuscript, and Mrs. Mae Day for secretarial assistance.

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