Bronchoscopic Myths and Legends: Is Age a Contraindication to Bronchoscopy?

Abstract

Given the aging of the US population and the prevalence of lung disease, which warrants diagnostic services in this population, we undertook a survey of pulmonary physicians in order to evaluate their attitudes toward bronchoscopy in the elderly. Specific areas of interest included concerns with regard to comorbidities, preprocedural testing, and perception of procedural complication rates. From November 2013 to January 2014, we surveyed 1896 pulmonary physicians via e-mail about their opinions with regard to bronchoscopy in the elderly. The Survey Monkey service was used to administer the survey. Almost 1900 physicians were contacted with a 12% response rate to the survey. Roughly half the respondents were in an academic setting (attendings or fellows), and the other half were in private practice. The majority of respondents felt that age was not a contraindication to bronchoscopy, that patients do not require routine preprocedural testing, and that good functional status plays a role in decision making with regard to procedural safety. Most respondents performed <25 bronchoscopies per year on the very elderly (patients 85 y of age or more). Overall, this study shows that, for the most part, the clinicians’ real life findings and experience reflect the available literature when it comes to bronchoscopy in the very elderly, and that our clinician respondents for the most part agreed that flexible bronchoscopy is generally a safe and well-tolerated procedure in the very elderly, and that this is a useful diagnostic tool for lung cancer, especially in the very elderly with good functional status.