Indications and Complications Associated with FiberOptic Bronchoscopy in Very Elderly Adults

Safety of flexible bronchoscopy and clinical course for elderly patients with suspected primary lung cancer

BACKGROUND

There have been several reports demonstrating the safety of flexible bronchoscopy (FB) in the elderly, but none have focused specifically on lung cancer, which is a frequent biopsy procedure.

METHODS

In this study, we retrospectively evaluated the safety of FB and subsequent treatment in elderly patients with suspected primary lung cancer. Elderly patients were defined as 75 years of age or older.

RESULTS

A total of 141 patients, 77 in the elderly group and 64 in the nonelderly group, were reviewed. The median age of the elderly group was 80 years. Transbronchial lung biopsy was performed in more than 80% of all patients. Primary lung cancer was diagnosed in 42 (54.4%) of the elderly group and 35 (54.7%) of the nonelderly group (p = 0.38). Approximately 70% of the elderly patients with a confirmed diagnosis were treated, while more than half of the undiagnosed elderly patients had best supportive care. Complications such as bleeding, pneumothorax, fever, and pneumonia were similar in the elderly and nonelderly groups.

CONCLUSIONS

This study suggests that flexible bronchoscopy can be performed as safely in the elderly as in the nonelderly. Furthermore, even elderly patients may have a greater chance of receiving treatment when a definitive diagnosis is achieved.

Safety and Efficacy of Flexible Bronchoscopy in Elderly Patients: A Retrospective Comparative Study

Background

Flexible bronchoscopy (FB) is a common method used for diagnostic sampling of the thorax. Although the safety and efficacy of FB in the general population are well-established, data on the elderly population are limited. This study aimed to determine the safety and efficacy of FB in elderly people aged ≥80 years.

Materials and Methods

We retrospectively studied elderly patients aged ≥80 years who underwent FB at our hospital between April 2021 and March 2022. Outcomes, such as indications, sampling methods, diagnostic results, and complications, were compared with those of a control group of patients aged 18-79 years.

Results

In total, 247 patients (154 men) were included in the study, with 65 and 182 patients in the elderly and non-elderly groups, respectively. The most frequent indication for FB was the presence of a mass or nodule, with transbronchial lung biopsy, transbronchial biopsy, and endobronchial ultrasound-guided transbronchial needle aspiration performed in 162 (65.6%), 29 (11.7%), and 36 (15.6%) patients, respectively. FB led to a diagnosis in 36 (57.1%) and 103 (56%) patients in the elderly and non-elderly groups, respectively, with no significant difference observed. There were no patient deaths or significant differences in the incidence of hemorrhage, hypoxia, pneumothorax, fever, or pneumonia between the two groups.

Conclusions

The findings of this study indicate that FB can be performed effectively and safely in elderly patients aged ≥80 years, similar to non-elderly patients.

Interventional pulmonology in elderly in tuberculosis and respiratory diseases-challenges

With the increasing number of the elderly population, the number of people with respiratory diseases along with other comorbidities is also increasing. With the good number of available evidence, the use of interventional pulmonary procedures is also increasing. However, the studies on the safety and therapeutic benefit of these procedures in the elderly population are limited. Because of the paucity of data, we decided to do a systematic review of the scientific literature that is currently available, to boost confidence to do these procedures by clinicians. This review deals with the procedures that are commonly performed in elderly respiratory patients, their indications, safety and the diagnostic and therapeutic yield, and compares them with the results in the younger population. It also focuses on the safety of anaesthetic techniques used for these procedures in the elderly. The bottom line of this review is that there is no significant difference between the older and younger age groups with regard to the above parameters and that age alone is not a criterion to decide whether the patients may undergo interventional pulmonary procedures.

Construction of a Risk Prediction Model for Fever After Painless Bronchoscopy

Background

The aim of this study was to construct a risk prediction model for fever after painless bronchoscopy.

Material/Methods

A total of 188 patients were included, and a self-designed data collection form was used. By collecting relevant clinical data of patients before, during, and after the painless bronchoscopy, the influencing factors were analyzed through univariate analysis, and multiple logistic regression analysis was performed to construct the prediction equation, which was tested by ROC curve analysis.

Results

Of the 188 patients undergoing painless bronchoscopy, 49 had postoperative fever, and the incidence rate was 26.0%. The prediction probability model was: P=e^x/1+e^x, where e is the natural logarithm, X=−4.337+0.020×(CRP)+1.014 (whether the examination time was greater than 30 minutes)+1.912×(whether remifentanil was used during anesthesia)+1.514×(whether nausea or vomiting occurred during surgery or during recovery). The prediction sensitivity and specificity were 78.26% 76.72%, respectively.

Conclusions

Use of this risk prediction model of fever after painless bronchoscopy can improve the recognition of people at high risk of postoperative fever, and it has good ability to guide clinical nursing observation and early screening of fever after painless bronchoscopy.

Interventional pulmonology techniques in elderly patients with comorbidities

Respiratory diseases are common cause of disability in the elderly and are often concomitant with other non-respiratory medical conditions. Interventional pulmonology includes advanced diagnostic and therapeutic techniques, successfully employed for benign and malignant pulmonary diseases with a good safety profile. A few studies are available on the efficacy and the safety of these procedures (both bronchoscopic and pleural techniques) in the elderly. Paucity of data in these patients may support reluctant clinicians. We carried out a non-systematic review aimed at describing the scientific literature on interventional pulmonology techniques in elderly patients with comorbidities. We summarized indications, performance characteristics, and safety profile of bronchoscopic techniques in the elderly, comparing outcomes between older and younger patients. We explored the role of age on anesthesia and sedation protocols during endoscopic procedures and assessed the influence of comorbidities on bronchoscopic outcomes. This review underlines that older age is not a barrier for implementing interventional pulmonology for diagnostic and therapeutic purposes.

The Safety and Utility of Fiberoptic Bronchoscopy in the Very Elderly

BACKGROUND

Flexible bronchoscopy (FB) is a common modality for diagnostic sampling within the thorax. It is utilized often in the elderly population, but there is limited data on the safety and utility of the procedure in the very elderly.

METHODS

FBs performed outside the intensive care unit in the San Antonio Military Health System on patients 85 years and older were reviewed. Outcomes including indications, complications, diagnostic yield, and final diagnosis were compared with a control group consisting of patients' ages of 65 to 79 years old.

RESULTS

Seventy-three bronchoscopies were performed in each group. The mean age of the older group was 87.1±2.6 years, and had a higher American Society of Anesthesiology (ASA) class than the younger group (P=0.03). There were no significant differences in the indications for bronchoscopy (P>0.05), sampling performed (P>0.05), complication rates (P>0.05), diagnostic yield (P>0.05), or final diagnoses (P>0.05). Similar proportions of each group with a malignancy diagnosis received some form of therapy (P>0.05), although fewer of the older group underwent surgery (P=0.03). Analysis of the cohort demonstrated that ASA class 3 to 4 was associated with increased rate of complications and use of anesthesia compared with lower ASA class (P<0.02).

CONCLUSION

FB in the elderly demonstrated no differences in procedural complications, diagnostic yield, and utility of the procedure for an underlying diagnosis. This study suggests bronchoscopy is as safe and useful in the very elderly as a population of the age of 65 to 79.

Aging Airways: between Normal and Disease. A Multidimensional Diagnostic Approach by Combining Clinical, Functional, and Imaging Data

The lack of data on lung function decline in the aging process as well as the lack of gold standards to define obstructive and restrictive respiratory disease in older people point out the need for a multidimensional assessment and interpretation of the aging airways. By integrating clinical data together with morphologic and morphometric findings clinicians can assess the airways with a more comprehensive perspective, helpful in the interpretation of the "grey zone" between normal aging and disease. This review focuses on the value of a multidimensional approach in the study of the aging airways, including clinical findings, respiratory function tests, and imaging as parts of a whole. Nowadays this multidimensional diagnostic approach can be used in daily clinical practice. In next future, it can be implemented by the analysis of exhaled gases, post-processing imaging techniques, and genetic analysis, that will hopefully reduce the gaps in knowledge of normal aging and airway disease in older people.