Forbearance With Bronchoscopy

Advanced technologies such as endobronchial ultrasound and electromagnetic navigation have revolutionized the field of bronchoscopy. Its indications as a diagnostic as well as a therapeutic tool continue to expand at a rapid pace. This growth also has led to the emergence of a new subspecialty of interventional pulmonology and more than 40 fellowship training programs. However, with increasing popularity and accessibility, there is a high impetus for performing the procedure when it may be of limited value. On the basis of a literature review and our own experience, we produced a list of conditions for which bronchoscopy is of limited value yet is being performed frequently. Conditions such as idiopathic pulmonary fibrosis, massive hemoptysis, cystic fibrosis, smear-negative pulmonary TB, and stage I sarcoidosis may be approached best in a more prudent fashion, with the bronchoscopic approach reserved for exceptional cases. We present an overview of conditions for which the expectations for bronchoscopy exceed the evidence in the literature, and we coined the term “forbearance with bronchoscopy” for situations in which this popular tool may not be the most appropriate initial approach. Advanced technologies such as endobronchial ultrasound and electromagnetic navigation have revolutionized the field of bronchoscopy. Its indications as a diagnostic as well as a therapeutic tool continue to expand at a rapid pace. This growth also has led to the emergence of a new subspecialty of interventional pulmonology and more than 40 fellowship training programs. However, with increasing popularity and accessibility, there is a high impetus for performing the procedure when it may be of limited value. On the basis of a literature review and our own experience, we produced a list of conditions for which bronchoscopy is of limited value yet is being performed frequently. Conditions such as idiopathic pulmonary fibrosis, massive hemoptysis, cystic fibrosis, smear-negative pulmonary TB, and stage I sarcoidosis may be approached best in a more prudent fashion, with the bronchoscopic approach reserved for exceptional cases. We present an overview of conditions for which the expectations for bronchoscopy exceed the evidence in the literature, and we coined the term “forbearance with bronchoscopy” for situations in which this popular tool may not be the most appropriate initial approach. ResponseCHESTVol. 156Issue 4PreviewWe acknowledge the well-written response by Dr Singh and colleagues to our publication “Forbearance with Bronchoscopy: A Review of Gratuitous Indications.”1 We agree that bronchoscopy plays a significant role in the management of hemoptysis. However, as the title suggests, our goal was to highlight situations in which the risks and benefits have to be assessed cautiously. If the clinical scenario allows, alternative, more efficient, and, sometimes, noninvasive methods should at least be considered before performing bronchoscopy. Full-Text PDF Forbearance With Recommendations: A Call to ActionCHESTVol. 156Issue 4PreviewWe read with great interest the publication by Deshwal et al1 in an issue of CHEST (April 2019). This is a most welcome article, and being an opinion piece by master bronchoscopists, it is therefore understood that certain statements will be based on eminence rather than evidence. Full-Text PDF ResponseCHESTVol. 156Issue 2PreviewWe thank the authors for the interest shown in our review article.1 The purpose of the paper was never to question the indications of bronchoscopy in specific populations, but to exercise restraint in certain situations. We think the paper has certainly succeeded in this task. The authors argue that transbronchial needle aspiration, either conventional or endobronchial ultrasound-guided, should be performed in all cases of sarcoidosis in developing countries. This is because one can diagnose TB in patients with clinical sarcoidosis. Full-Text PDF Should Performing Bronchoscopy on Suspected Stage I Sarcoidosis Be Stopped Even in Developing Countries?CHESTVol. 156Issue 2PreviewWe read the paper in CHEST (April 2019) by Deshwal et al1 which discusses some diseases that bronchoscopy may not be used as a diagnostic or therapeutic tool. The paper offers a different perspective about bronchoscopy against its increasing usage. In daily practice, if you are a bronchoscopist and another physician requested a bronchoscopy, it is boring to do the procedure knowing that you will not really come to the diagnosis. In this respect, the paper shows diseases and therapeutic conditions to prevent its unnecessary usage. Full-Text PDF