Bronchoscopy in North America

Abstract

Our objective was to obtain information regarding the opinions and practice habits of pulmonary physicians who perform diagnostic and therapeutic bronchoscopy in North America. The last survey of clinical bronchoscopic practice in North America was conducted by the American College of Chest Physicians in 1989. During the past 10 years, however, bronchoscopy has evolved considerably. Numerous published clinical investigations, symposia, and training courses have accompanied a renewed interest in both advanced diagnostic and therapeutic procedures. Whether this has resulted in modifications of bronchoscopic practice, however, is unknown. To gain greater insight into practitioners' opinions and practice habits, the American Association for Bronchology conducted this survey. An eight-page survey was mailed to 2,500 pulmonologists selected randomly from the American College of Chest Physicians (ACCP) membership roster. The survey was designed so that only bronchoscopists with experience in certain procedures addressed specific issues pertaining to those procedures. Many questions were designed intentionally to allow direct comparisons with responses from the previous ACCP survey. A total of 744 questionnaires (30% return rate) were analyzed. Respondents were similarly representative of all major regions of the United States. A total of 99% of the respondents were familiar with flexible (fiberoptic) bronchoscopy, but only 4.5% had performed stent insertions or laser resections. The majority of respondents (82 to 87%) thought that our pulmonary societies needed to prepare detailed guidelines pertaining to the practice of both flexible (82%) and therapeutic (87%) bronchoscopy. The results from this survey provide helpful information that may prompt reconsideration of existing procedure-related training and competency issues. Overall, therapeutic procedures such as bronchoscopic stent (prosthesis) insertion or laser bronchoscopy do not appear to be practiced widely or frequently, suggesting a potential move toward development of tertiary care centers of excellence for patients who require advanced therapeutic airway procedures.