Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations.

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.

A multicenter study on the safety and efficacy of bronchial thermoplasty in adults with severe asthma.

BACKGROUND AND AIM: Bronchial thermoplasty (BT) is a treatment option for patients with severe asthma. BT involves controlled delivery of radiofrequency energy using a bronchoscopic catheter, thereby reducing bronchial hyperreactivity. Herein, we describe our experience on the safety and efficacy of BT in severe asthma. METHODS: This was a retrospective multicenter study of subjects who underwent BT at four centers across India. RESULTS: We included 36 subjects (mean ± standard deviation [SD] age, 50.9 ± 11.5 years, women [69.44%]) undergoing 105 BT treatment sessions. All the subjects met the American Thoracic Society/European Respiratory Society criteria for severe asthma, 22.2% were requiring oral maintenance glucocorticoids. The mean ± SD baseline %predicted forced expiratory volume in one second (FEV1) was 62.07 ± 18.54. The median interquartile range (IQR) annual asthma exacerbation rate in the year preceding BT was 3.5 (1-10). We encountered intraprocedural complications in 7 (6.7%) sessions. An exacerbation of asthma following BT occurred in 6 (5.7%) procedures. We observed a significant improvement in the asthma control test and the asthma control questionnaire scores following BT. The quality of life (asthma quality of life questionnaire) also significantly improved. We noted a significant reduction in the number of exacerbations following BT (median [IQR], 3 [1-10] per year pre-BT versus 0.5 [0-3] per year post-BT, P < 0.001). No significant change occurred in the %predicted FEV1 following BT. CONCLUSION: BT is a feasible treatment option in patients with severe asthma. More extensive studies are required to establish the efficacy of BT in real-life settings.

Conventional flexible bronchoscopy during the COVID pandemic: A consensus statement from the Indian Association for Bronchology.

During the times of the ongoing COVID pandemic, aerosol-generating procedures such as bronchoscopy have the potential of transmission of severe acute respiratory syndrome coronavirus 2 to the healthcare workers. The decision to perform bronchoscopy during the COVID pandemic should be taken judiciously. Over the years, the indications for bronchoscopy in the clinical practice have expanded. Experts at the Indian Association for Bronchology perceived the need to develop a concise statement that would assist a bronchoscopist in performing bronchoscopy during the COVID pandemic safely. The current Indian Association for Bronchology Consensus Statement provides specific guidelines including triaging, indications, bronchoscopy area, use of personal protective equipment, patient preparation, sedation and anesthesia, patient monitoring, bronchoscopy technique, sample collection and handling, bronchoscope disinfection, and environmental disinfection concerning the coronavirus disease-2019 situation. The suggestions provided herewith should be adopted in addition to the national bronchoscopy guidelines that were published recently. This statement summarizes the essential aspects to be considered for the performance of bronchoscopy in COVID pandemic, to ensure safety for both for patients and healthcare personnel.