Bronchoscopy and bronchial biopsy are safe and useful procedures in the evaluation of severe uncontrolled asthma

Abstract

Introduction: Severe uncontrolled asthma (SUA) is a heterogeneous condition currently managed using clinical characteristic and biomarkers such as allergic status and blood eosinophil counts. We aimed to demonstrate that bronchoscopy(BC) and bronchial biopsy(BB) are useful and safe procedures in the assessment of SUA. Methods: Retrospective analysis with longitudinal follow up of patients referred to a difficult asthma clinic for biologic therapy. BC was performed when no clear relation to allergy was suspected. A prospective standardized evaluation of BB was performed by an expert pathologist including: eosinophil count per field, presence of epithelial denudation, goblet cell hyperplasia, squamous metaplasia, basement membrane thickening, smooth muscle hyperplasia and submucosal glands, presence of neutrophils and mast cells in submucosa. Side effects, final diagnosis and biologic therapy were evaluated. Results: 58 patients with SUA were included, 34 of them underwent a BC. None had a complication during the procedure. An aggravating factor explaining the lack of control was found in 17 patients, mostly, infections (7 patients), signs of GERD (6), vocal cord dysfunction (2) and tracheobronchomalacia (1). 21 patients underwent bronchial biopsy, 3 samples were not representative. In 44% of the BB, an eosinophil count in the submucosa>10 cells/field was found and a biologic therapy was initiated in 75% of these patients. 61% showed an eosinophil count in the submucosa Conclusions: BC is a safe procedure that can help to characterize the poor response to standard therapy for asthma. The use of BB is useful in the decision-making of biologic therapy.