• Borja G Cosío, Hanaa Shafiek, Mar Mosteiro, Amanda Iglesias, Cristina Gómez, Nuria Toledo-Pons, Rocio Martinez, Meritxell Lopez, Escribano GimenoInésIDepartment of Respiratory Medicine, Hospital Infanta Sofía, Madrid, Spain., and Luis Pérez de Llano.
• Department of Respiratory Medicine, Hospital Universitario Son Espases. Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain; Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain. Electronic address: borja.cosio@ssib.es.
• Chest. 2023 Oct 1; 164 (4): 837845837-845.

BackgroundSevere uncontrolled asthma (SUA) is frequently treated with biologic therapy if a T2 phenotype is found. Bronchoscopy is not routinely recommended in these patients unless a specific indication to rule out comorbidities is present.Research QuestionIs routine bronchoscopy safe and useful in phenotyping and endotyping patients with SUA before the indication of a biologic therapy?Study Design And MethodsProspective study of consecutive patients with SUA who were referred to a specialized asthma clinic to assess the indication of a biologic therapy. Patients were clinically phenotyped as T2-allergic, T2-eosinophilic, and non-T2. All patients underwent bronchoscopy, and systematic data collection of endoscopic findings, microbiology of bronchial aspirate, and presence of eosinophils in bronchial biopsy were recorded and compared between asthma phenotypes. Cluster analysis was performed accordingly.ResultsOne hundred patients were recruited and classified as T2-allergic (28%), T2-eosinophilic (64%), and non-T2 (8%). On bronchoscopy, signs of gastroesophageal reflux disease were detected in 21%, vocal cord dysfunction in 5%, and tracheal abnormalities in 3%. Bronchial aspirate culture isolated bacteria in 27% of patients and fungi in 14%. Three clusters were identified: nonspecific, upper airway, and infection, the latter being less frequently associated with submucosal eosinophilia. Eosinophils were detected in 91% of bronchial biopsies. Despite a correlation to blood eosinophils, five patients with T2-phenotypes showed no eosinophils in bronchial biopsy, and three patients with non-T2 showed eosinophils in bronchial biopsy. Only one patient had moderate bleeding.InterpretationRoutine bronchoscopy in SUA eligible for biologic therapy is a safe procedure that can help to better phenotype and personalize asthma management.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

16 keywords...

hide…