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Pneumothorax After Transbronchial Biopsy in Pulmonary Fibrosis: Lessons from the Multicenter COMET Trial

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Abstract

Purpose

Some patients with diffuse interstitial lung disease (ILD) undergo bronchoscopy with transbronchial biopsy (TBB) as part of their diagnostic evaluation. It is unclear what the incidence and risk factors for pneumothorax (PTX) following TBB are in this patient population.

Methods

Ninety-seven subjects with pulmonary fibrosis who underwent a research bronchoscopy with TBB as part of the multicenter correlating outcomes with biochemical markers to estimate time-progression in idiopathic pulmonary fibrosis (COMET) trial were retrospectively reviewed. We compared subjects who developed a PTX during research bronchoscopy with TBB versus those who did not.

Results

Seven patients (7.2%) experienced a PTX during research bronchoscopy with TBB. Subjects who experienced PTX during TBB had significantly lower DLCO percent predicted (29 ± 8 vs. 45 ± 15, P = 0.006) and had lower resting room air saturation of peripheral oxygen (SPO2) on 6-min walk testing (91 ± 10 vs. 95 ± 3, P = 0.02). No differences between groups were found with respect to age, gender, race, BMI, HRCT characteristics, or the number of transbronchial biopsies performed.

Conclusion

The incidence of PTX following research bronchoscopy with TBB in patients with pulmonary fibrosis was found to be 7.2% in this study. Patients who developed a pneumothorax had greater impairments in gas exchange at baseline evidenced by a lower DLCO  % predicted and a lower resting room air SPO2 compared with subjects without PTX as a complication.

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Abbreviations

6MWT:

Six-minute walk test

BAL:

Bronchoalveolar lavage

BMI:

Body mass index

COMET:

Correlating outcomes with biochemical markers to estimate time-progression in IPF

COPD:

Chronic obstructive pulmonary disease

DLCO :

Diffusion capacity of carbon monoxide

FEV1 :

Forced expiratory volume in the first second

FVC:

Forced vital capacity

HRCT:

High-resolution computed tomography

ILD:

Interstitial lung disease

IPF:

Idiopathic pulmonary fibrosis

NHANES:

National health and nutrition examination survey

SPO2 :

Saturation of peripheral oxygen

PTX:

Pneumothorax

TBB:

Transbronchial biopsy

UIP:

Usual interstitial pneumonia

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Funding

This work was supported by the National Institutes of Health (Grant 1RC2HL101740-01).

Author information

Authors and Affiliations

  1. Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA, 19140, USA

    Jonathan A. Galli, Nicholas L. Panetta, Nathaniel Gaeckle & Gerard J. Criner

  2. University of Michigan, Ann Arbor, MI, USA

    Fernando J. Martinez, Bethany Moore, Thomas Moore, Anthony Courey & Kevin Flaherty

Authors
  1. Jonathan A. Galli
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  2. Nicholas L. Panetta
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  3. Nathaniel Gaeckle
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  4. Fernando J. Martinez
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  5. Bethany Moore
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  6. Thomas Moore
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  7. Anthony Courey
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  8. Kevin Flaherty
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  9. Gerard J. Criner
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Consortia

for the COMET investigators

Contributions

Dr. Galli and Dr. Panetta contributed to the study concept and design, analysis and interpretation of data, and drafting and revision of the manuscript. Dr. Gaeckle performed statistical analysis, interpretation of data, and figure rendering. Dr. Criner served as the guarantor of the paper, contributed to the study concept and design, analysis and interpretation of the data, critical revision of the manuscript for important intellectual content, and approval of the final manuscript. Dr. Martinez, Dr. Bethany Moore, Dr. Thomas Moore, Dr. Courey, and Dr. Flaherty contributed to the study concept and design, and analysis and interpretation of the data.

Corresponding author

Correspondence to Jonathan A. Galli.

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The authors declare that they have no conflict of interest.

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Galli, J.A., Panetta, N.L., Gaeckle, N. et al. Pneumothorax After Transbronchial Biopsy in Pulmonary Fibrosis: Lessons from the Multicenter COMET Trial. Lung 195, 537–543 (2017). https://doi.org/10.1007/s00408-017-0028-z

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  • DOI: https://doi.org/10.1007/s00408-017-0028-z

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