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Endobronchial biopsy

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A report in

gave details of 73 children (38 with severe asthma) who had undergone bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy under general anaesthesia at two specialist centres. It was concluded that the procedures were safe and acceptable to parents. Two more papers on endobronchial biopsy appeared in a recent issue of Thorax. In Springfield, Massachusetts (

) 170 children aged 2.5–16 years underwent bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy using a flexible bronchoscope with a laryngeal mask airway and general anaesthesia. At least three biopsies were taken at each procedure. Children under 4 years were given a single intravenous dose of antibiotic after the procedure. The most common reasons for bronchoscopy were chronic cough (98 patients), asthma (39), and recurrent pneumonia (15). The children tolerated the procedure well. None needed topical adrenaline to control bleeding and none developed pneumothorax, haemoptysis, pneumonia, or significant fever. One patient had an episode of prolonged oxygen desaturation that resolved with positive pressure ventilation. Attempted biopsies on three children aged 6-30 months produced inadequate specimens.

The report from London (

) concerns 33 children aged under 5 years (mean 31 months, range 4 to 59 months) who underwent bronchoscopy, bronchoalveolar lavage, and biopsy and 33 controls who had bronchoscopy, and usually lavage, without biopsy. Bronchoscopy was done with a flexible bronchoscope under general anaesthesia. The reasons for bronchoscopy were similar to those in the American series. Adequate biopsies were obtained from 30 children. Complications during the procedure included cough, oxygen desaturation, and laryngospasm. After the procedure fever was the most common complication, occurring in 16 of the 66 children. Intraprocedural complications occurred in six of 33 children with biopsy and 8 of 33 without biopsy. Postprocedural complications occurred in 13 and seven respectively. Neither intra- nor postprocedural complications were significantly more common in the biopsied group. Clinical management was influenced by the biopsy findings in 16 of 27 children with cough or recurrent lower respiratory tract infection as the indication for biopsy.

Endobronchial biopsy appears to be fairly safe in young children, adding little to the risk of bronchoscopy and bronchoalveolar lavage. The London workers envisage it as a research tool for investigating young children with asthma. Such research should be confined to experienced specialist centres, and presumably to children with severe asthma in whom the investigation might be considered on purely clinical grounds.

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