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There are other studies suggesting sample repeatability was acceptable, with correlation
coefficients between O.7-O.87 for macrophage, lymphocyte, neutrophil and eosinophil counts
in asthmatic, rhinitis, CF and normal subjects (Pin, Gibson et al. 1992; in 't Veen, de Gouw et
al. 1996; Spanevello, Migliori et al. 1997; Bacci, Cianchetti et ^1. 2002; Beier, Beeh et al.
2004; Smountas, Lands et al. 2004).The repeatability of the soluble markers albumin,
fibrinogen, IL8 and ECP were also thought to be acceptable in adult subjects with mild to
moderate asthma (in't Veen, de Gouw et al. 1996).
Performing all of these procedures requires highly experienced staff, particularly with
children, also recognising the need for general anaesthesia for bronchoscopy, as well as highly
qualified laboratory technicians (see Section L.6.4 (iii) below regarding safety). The
procedures are time-consuming which limits their use in clinical practice. For sputum
induction, it is estimated that should a patient produce a suitable sample within 10 minutes of
starting the procedure (and it can take up to 30 minutes) in a well practiced laboratory, the
total time required for processing through to a result is 100 minutes and the sample requires
processing within 2 hours of collection (Holz, Kips et al. 2000). The time spent to make the
procedure 'child friendly' is likely to be longer. The CAMP researchers across eight centres
commented "this procedure still remains a research tool in asthma because of its requirements
for technical expertise" (Covar, Spahn et al. 2OO4).
1.6.a (iv) Safety aspects of bronchoscopy, bronchial biopsy, bronchoalveolar lavage and/or
induced sputum
In 159 asthmatic adults undergoing 273 bronchoscopies in six studies, there were 34 adverse
event episodes which included bronchospasm, pleuritic chest pain, shortness of breath, fever,
fluJike symptoms and haemoptysis @lston, Whittaker et al.2004). Another safety review
reported that after six to eight biopsies taken per procedure in 57 patients; 40Vo had cough,
l2Vo cough and bronchospasm and3.5Vo required additional rescue medication (Iapanainen,
Lindqvist et al.2N2). Arterial saturation decreased in 50 asthmatic patients from a mean of
977o Io a mean of 92Vo and from 98Vo to 93Vo in 25 normal subjects during bronchoscopy and
biopsy, without correlation to the pre-operative lung functions tests (Van Vyve, Chanez et al.
1992). Bacteraemia is also described with fibreoptic bronchoscopy, with 26 of 200
consecutive patients having positive blood cultures after the procedure despite the majority of
patients having no prior respiratory illness (Yigla, Oren et al. 1999). A prospective analysis of
the financial cost of complications from flexible bronchoscopy over a 30 month period
revealed of the 1,009 bronchoscopies performed in 660 adults as an outpatient procedure,
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