Impact of atropine and hydroxyzine pretreatment in contemporary bronchoscopy

Bronchoscopy is essential for diagnosing and managing respiratory diseases. However, secretions and airway reflexes can impair procedural quality and patient comfort. While anticholinergic pretreatment using agents such as atropine and hydroxyzine has historically mitigated these physiological responses, recent guidelines discourage their routine use because of concerns regarding hemodynamic changes and uncertain benefits. This study aimed to assess the efficacy of anticholinergic pretreatment during contemporary bronchoscopy.

We conducted a single-center, cross-sectional study comparing two cohorts of patients who underwent bronchoscopy with transbronchial and ultrasound-guided needle biopsies. Group A (n = 35) received pretreatment with intramuscular atropine (0.5 mg) and hydroxyzine (25 mg) between July 2022 and September 2023, while Group B (n = 35) underwent procedures without pretreatment between December 2024 and March 2025. Patient discomfort was evaluated using a visual analog scale. Propensity score adjustment with inverse probability of treatment weighting (IPTW) accounted for differences in baseline factors.

Seventy patients were included (n = 35 per group). After IPTW adjustment, Group B reported greater distress from salivation and cough and lower willingness for repeat bronchoscopy (p = 0.03, p = 0.02, p = 0.001, respectively). Group B also showed higher use of lidocaine (p < 0.001). No significant differences in midazolam dosage or vital signs were observed among either group.

Anticholinergic pretreatment may reduce procedural discomfort, particularly that associated with secretions and airway reflexes, without evident adverse effects. Further randomized controlled trials are required to validate the role of pretreatment in contemporary bronchoscopy.