Complications and safety analysis of diagnostic bronchoscopy in COPD: a systematic review and meta-analysis

ABSTRACT

Background

Chronic obstructive pulmonary disease (COPD) often coexists with many diseases that require bronchoscopy. We conducted this systematic review and meta-analysis to assess the safety and complication rate of diagnostic bronchoscopy in patients with COPD.

Methods

We retrieved clinical trials that reporting the complications of conducting diagnostic bronchoscopy on patients with COPD through electronic databases. Analyses of the overall major complication rate of bronchoscopy and potential risk factors in patients with COPD were conducted.

Results

18 trials/arms were evaluated. The overall major complication rate of bronchoscopy was 4.3% (95% CI, 2.2%-8.2%; 18 trials/arms, n = 2000). The major complication rate of the patients with an exacerbation of COPD was higher than that of the stable patients (7.8% vs. 4.5%, Q-value = 11.29, df (Q) = 1, p < 0.01); using of sedative medicine was also related with higher major complication rate (Q-value = 6.303, df (Q) = 2, p = 0.043). Patients with severe COPD who were GOLD stages III and IV (Q = 13.40, df = 1, p < 0.01; R² = 0.66) or had a high BMI (Q = 30.83, df = 1, p < 0.01; R² = 0.91) more easily encountered complications during bronchoscopy.

Conclusions

The major complication rate of diagnostic bronchoscopy in patients with COPD was acceptable and low Exacerbations of COPD and using sedative medicine were related with higher major complication rate.

Expert opinion

COPD is a major risk factor for lung cancer and infection, so the patients with COPD often required bronchoscopy. Although our results showed diagnostic bronchoscopy might not be more fatal for patients with COPD, further studies are needed to explore the potential risk factors for major complications of bronchoscopy in patients with COPD.

KEYWORDS:

• COPD
• bronchoscopy
• complication
• safety

Article highlights

• Diagnostic bronchoscopy might not be more fatal for patients with COPD.

• The major complication rate of diagnostic bronchoscopy for patients with an exacerbation of COPD was higher than that of stable patients, and using of sedative medicine was related with higher overall major complication rate for the patients with COPD.

• GOLD stages III and IV and high BMI might be potential risk factors for major complications in patients with COPD.

Abbreviations

COPD: Chronic obstructive pulmonary disease; GOLD: Global initiative for chronic obstructive lung disease; BMI: Body mass index; BAL: Bronchoalveolar lavage; CI: Confidence interval; PRISMA: preferred reporting items for systematic reviews and metaanalyses; NA: Not applicable; FEV1: Forced expiratory volume in 1 second; FVC: Forced vital capacity; ICU: Intensive care unit; AECOPD: Acute exacerbations of COPD.

Authors’ contributions

All authors contributed to the inception of the research question and study design. T.Y. Zhu and D.B. Ma also contributed to the data collection and manuscript composition. Y. Chen contributed to the data analysis. C.C. Li and L.Y. Bo were responsible for the integrity of this work and contributed to the study design and manuscript review. All authors contributed to drafting the manuscript and have read and approved the final manuscript.

Declaration of Interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed https://doi.org/10.1080/17476348.2022.2056023