Bronchial asthma

In the past few years fibreoptic bronchoscopy and bronchoalveolar lavage fluid analysis have been extended to subjects with asthma and they are increasingly used to study airway cell profile and fluid components, as well as to study the characteristics of the harvested cells in vitro [198, 264, 265]. Initial studies were performed in stable asthmatics who were free of bronchospasm, and suggested that bronchoalveolar lavage could be safely performed as a research tool in carefully selected, asymptomatic asthmatic subjects. The guidelines provided by two international committees set up to evaluate the use of bronchoalveolar lavage and record its application, recognized and established the safety of the procedure in those selected patients [1, 266]. Many studies have been carried out without major complications on stable asthmatics before and after bronchoprovocation with allergens or occupational agents, and an international workshop on the use of bronchoalveolar lavage in asthma established the criteria to perform this procedure safely during the course of asthmatic responses to asthmogenic stimuli, as a research tool [266]. The general conclusion from the literature is that the bronchoalveolar lavage technique is safe in asthma, and that as long as reasonable guidelines are chosen for the selection of patients, the mortality is zero and the morbidity is very low. However, special care should be exercised in asthmatic patients with marked bronchial responsiveness, and supplemental oxygen delivery and electrocardiographic (ECG) monitoring is strongly advised in patients with severe underlying diseases or in any critical conditions [1, 198, 266]. Additional criteria are provided to select patients to undergo bronchoalveolar lavage following aerosol or local bronchoprovocation [266].