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Safety and ethics of bronchoscopy and endobronchial biopsy in difficult asthma
D Payne1, S A McKenzie, S Stacey
1Department of Paediatrics, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK.
Insights
Bronchoscopy and endobronchial biopsy are safe procedures for children with difficult asthma. These investigations, performed by trained professionals, are well-tolerated by families.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Medical Ethics
Background:
- Difficult asthma in children presents complex management challenges.
- Diagnostic procedures are essential for accurate diagnosis and treatment planning.
- Ethical considerations are paramount when performing invasive procedures on pediatric patients.
Purpose of the Study:
- To evaluate the safety and feasibility of bronchoscopy and endobronchial biopsy in pediatric patients with difficult asthma.
- To explore the ethical implications of performing these procedures in this specific population.
Main Methods:
- A prospective observational study was conducted over three years in two tertiary pediatric respiratory centers.
- The study included 48 children diagnosed with difficult asthma and 35 non-asthmatic children.
- Procedures included flexible and rigid bronchoscopy, with endobronchial biopsy performed in most participants.
Main Results:
- Bronchoscopy and endobronchial biopsy were performed under general anesthesia.
- Perioperative complications were infrequent in children with difficult asthma (one in flexible, two in rigid bronchoscopy).
- Complication rates were higher in non-asthmatic children undergoing flexible bronchoscopy.
Conclusions:
- Bronchoscopy and endobronchial biopsy are safe when performed by experienced teams in children with difficult asthma.
- The procedures were found to be ethically acceptable to the families involved.
- These diagnostic tools can be safely utilized in managing complex pediatric asthma cases.
Aim:
To investigate the safety of bronchoscopy and endobronchial biopsy in children with difficult asthma, and discuss the ethical issues associated with the procedure.
Methods:
A three year prospective observational study was performed in two tertiary paediatric respiratory centres specialising in the management of children with difficult asthma. A total of 48 children with difficult asthma and 35 non-asthmatic children were studied.
Results:
Flexible bronchoscopy was performed under general anaesthesia in 38 children with difficult asthma, and rigid bronchoscopy was performed in 10, following a two week course of prednisolone. Endobronchial biopsy was performed in 47 patients. Perioperative complications occurred in one asthmatic undergoing flexible bronchoscopy (desaturation) and in two undergoing rigid bronchoscopy (desaturation in one, and bronchospasm and desaturation in one). There were no cases of significant bleeding or pneumothorax among the asthmatics. Flexible bronchoscopy was performed in 35 non-asthmatic patients with a variety of clinical indications. The total number of perioperative complications was greater in the non-asthmatics undergoing flexible bronchoscopy than in the asthmatics (17 complications in 35 children versus one in 38). Fever requiring hospital admission was documented in two asthmatics following bronchoscopy. Four asthmatics reported an increase in symptoms in the week following bronchoscopy.
Conclusions:
Bronchoscopy and endobronchial biopsy under general anaesthesia can be performed safely in children with difficult asthma, when the bronchoscopist and anaesthetist are suitably trained. The procedure is acceptable to the families involved.