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complications occulred in SVo necessitating hospital admission in 0.5Vo, resulting in an
additional cost of US $6,996 to treat complications but with an additional US $34,500 in
those requiring hospitalisation (Colt and Matsuo 2001).
The largest study looking at side effects with flexible bronchoscopies in children, was a
retrospective analysis of 2,836 procedures over 2l years, which concluded that it was a safe
procedure. However 2l had life threatening hypoxaemia, l7 had laryngospasm or
bronchospasm and 4Vo had nasopharyngeal bleeding (Nussbaum 2002). A large prospective
study of 1,328 procedures (excluding intensive care examinations) recorded at least one
complication in 6.9Vo of cases, of which 5.2Vo were mild and l3To were major with one
pneumothorax (de Blic, Marchac et al. 2002).In 170 children with respiratory symptoms
having bronchoscopy and lavage plus at least three endobronchial biopsies, fluctuations of
oxygen saturation and end tidal carbon dioxide (CO, were seen in all patients but only one
had a prolonged desaturation episode. In addition, minor bleeding was demonstrated at the
site of the biopsies but no other side effects occurred (Salva, Theroux et al.2N3). Of 3g
asthmatic children undergoing bronchoscopy, one had desaturation, two had fever and in four
their asthma worsened over the following week. Of 35 non-asthmatic children undergoing
bronchoscopy for another reason (not 'normals'), there were there were 17 adverse events
which were predominantly laryngospasm and apnoea (Payne, McKenzie et al. 2001). In 66
children < 5 years of age a comparison was made between having bronchoalveolar lavage
alone and the addition of endobronchial biopsies with approximately half the group in each.
Complications occurred in 24Vo and, lSVo respectively including cough, desaturation, apnoea
and laryngospasm (Saglani, Payne et al. 2OO3). In 42 CF children and 39 with other
indications for bronchoscopy, the complication rate was l3.37o and, l7.97o respectively
(Molina-Teran, Hilliard et al. 2006).
So despite the progress in knowledge from the biopsy and lavage studies - they are still
invasive, require bronchoscopy, and sedation in adults and often general anaesthesia in
children. It is therefore particularly difficult to justify use of these techniques in early age
groups and/or repeatedly which is where the most knowledge regarding progression of disease
is likely to come. Discussions about safety in the literature has presented both pro and con
arguments (Connett 2000; Larsen and Holt 2000; Shields and Riedler 2000) ending with one
commentator suggesting "because of the invasive nature of the investigation there arc few
conditions for which repeat sampling can be justified" (Connett 2000). The debate has
continued more recently with a series of letters discussing the appropriateness of biopsy in
particular as a research tool in children (Mallory 2006;Bush and Davies zo07).
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