Experiences of research bronchoscopy among middle-aged participants with normal lung function and with COPD

Pernilla Sönnerfors^1*Petra Kristina Jacobson²Anders Andersson³Leif Hilding Bjermer⁴Anders Blomberg⁵Heléne Blomqvist⁶Christer Jansson⁷Jonas S Erjefält⁸Hans Lennart Persson²Ellen Tufvesson⁴Åsa M Wheelock⁹Magnus Carl Sköld⁹Annelie Behndig⁵

• ¹Medical Unit Occupational therapy and Physiotherapy, Women´s Health and Allied Health Professionals Theme, Karolinska University Hospital, Department of Medicine Solna, Division of Immunology and Respiratory Medicine, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
• ²Department of Respiratory Medicine in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
• ³COPD Center Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, COPD Center Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
• ⁴Department of Clinical Sciences, Respiratory medicine, allergology and palliative medicine, Lund University, Lund, Sweden
• ⁵Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
• ⁶Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Department of Medicine Solna, Division of Immunology and Respiratory Medicine, Center for Molecular Medicin, Karolinska Institutete,, Stockholm, Sweden
• ⁷Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
• ⁸Unit of Airway Inflammation, Department of Experimental Medicine Sciences, Lund University, Lund, Sweden
• ⁹Department of Medicine Solna, Division of Immunology and Respiratory Medicine, Center for Molecular Medicine. Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

Introduction: Flexible bronchoscopy is regarded as a safe examination and is commonly used in the diagnostic work-up for lung diseases, but is also important in pulmonary research. We aimed to investigate participants' experiences when undergoing bronchoscopy in a research setting. Methods: Participants were recruited from the Swedish CArdioPulmonary bioImage Study (SCAPIS). A subset from this cohort (n=45, mean age 60.5 years, 20 with normal lung function and 25 with chronic obstructive pulmonary disease, COPD) was selected for bronchoscopy. The procedure was explained both orally and in writing during a pre-procedure visit. The information included premedication, monitoring, local anaesthesia, airway sampling (bronchoalveolar lavage (BAL), bronchial wash, and mucosal biopsies), and urine and blood samples. Questionnaires pre- and/or post-procedure were used to assess experiences and health impacts. Results: In general, participants found the bronchoscopy procedure acceptable and only a few (18%) found it unpleasant. A majority (80%) reported their experience to be much better or as expected. Almost all participants (93%) were very satisfied with the information provided. Topical anesthesia was seen as more unpleasant (20%) than airway sampling (11%). Notably, more women and participants with normal lung function reported BAL as unpleasant. After the procedure, chills, fever, and hemoptysis were reported, but no serious adverse events occurred. Increased cough and phlegm were noted. Conclusions: The present study, conducted by experienced bronchoscopists and healthcare teams, demonstrates that a bronchoscopy in a research setting in well-informed participants with normal lung function or COPD was well-tolerated.