Background: The use of bronchoscopy and broncho-alveolar lavage (BAL) in Cystic Fibrosis (CF) is controversial.
Aim: To define the role of bronchoscopy and BAL in guiding clinical management of CF patients.
Methods: A ten year retrospective analysis of all CF patients’ charts from two CF centers (Hadassah in Jerusalem and Schneider in Petach Tikva) between 2007 -2017 was performed. All patients who underwent bronchoscopy were included. BAL culture results were compared to the closest (~ 1 month) pre-bronchoscopy sputum sample. Positive yield was defined as a change in antibiotic treatment as a result of the BAL culture or resolution of the clinical problem leading to bronchoscopy.
Results: Three hundred twenty four patients` charts were screened, and 105 bronchoscopies in 44 patients identified (2.4 bronchoscopies/patient). The mean age was 9.7 years (median 6yr, range: 0.5-47), 80% of with pancreatic insufficiency. Thirty two (30%) bronchoscopies had a positive clinical yield. The microbiological yield of bronchoscopies in patients >5 years was superior to non-bronchoscopy culture in identification of important opportunistic pathogens (e.g. non-tuberculous mycobacteria, Burkholderia cepacia, Serratia marcescens). In children ≤5 years, bronchoscopy cultures were superior for isolation of Haemophilus influenza, Streptococcus pneumoniae and Moraxella catarhalis. The only parameter to predict a positive yield was a finding of thick copious mucus on bronchoscopy (OR: 3.4, CI95%: 1.3-9.1, p=0.01). No severe complications were reported and pulmonary functions remained stable (average FEV1 decline - 0.9%/year).
Conclusion: In selected circumstances, bronchoscopy and BAL can add clinically useful information and impact clinical management, specifically by identifying important pathogens, even in older expectorating patients.
