The clinical yield of bronchoscopy in the management of cystic fibrosis: A retrospective multicenter study

Abstract

Background: Pulmonary disease is the leading cause of morbidity and mortality in people with cystic fibrosis (pwCF). Several studies have shown no benefit for bronchoscopy and bronchoalveolar lavage (BAL) over sputum to obtain microbiological cultures, hence the role of bronchoscopy in pwCF is unclear.

Aim: To analyze how bronchoscopy results affected clinical decision-making in pwCF and assess safety.

Methods: A retrospective analysis of all charts of pwCF from three CF centers in Israel, between the years 2008 and 2019. We collected BAL culture results as well as sputum cultures obtained within 1 month of the BAL sample. A meaningful yield was defined as a decision to start antibiotics, change the antibiotic regimen, hospitalize the patient for treatment, or the resolution of the problem that led to bronchoscopy (e.g., atelectasis or hemoptysis).

Results: During the study years, of the 428 consecutive patient charts screened, 72 patients had 154 bronchoscopies (2.14 bronchoscopies/patient). Forty-five percent of the bronchoscopies had a meaningful clinical yield. The finding of copious sputum on bronchoscopy was strongly associated with a change in treatment (OR: 5.25, 95%CI: 2.1-13.07, p < 0.001). BAL culture results were strongly associated with a meaningful yield, specifically isolation of Aspergillus spp. (p = 0.003), Haemophilus influenza (p = 0.001). Eight minor adverse events following bronchoscopy were recorded.

Conclusions: In this multicenter retrospective analysis of bronchoscopy procedures from three CF centers, we have shown that a significant proportion of bronchoscopies led to a change in treatment, with no serious adverse events. Our findings suggest that bronchoscopy is a safe procedure that may assist in guiding treatment in some pwCF. Future studies should evaluate whether BAL-guided decision-making may also lead to a change in clinical outcomes in pwCF.

Keywords: bronchoscopy; cystic fibrosis; sputum cultures.

Figure 1

Bar chart showing BAL culture results compared to the closest (<1 month) pre‐bronchoscopy sputum sample. Microbiological flora obtained from bronchoscopy and sputum cultures. Each bar chart shows the percentage (rounded to the nearest number) of pathogens detected in the samples out of the total tests. BAL, bronchoalveolar lavage; MRSA, methicillin‐resistant Staphylococcus aureus; MSSA, methicillin‐sensitive S. aureus; Strep. pneumoniae, Streptococcus pneumoniae.