RESUMEN
BACKGROUND: Flexible bronchoscopy (FB) is a common modality for diagnostic sampling within the thorax. It is utilized often in the elderly population, but there is limited data on the safety and utility of the procedure in the very elderly. METHODS: FBs performed outside the intensive care unit in the San Antonio Military Health System on patients 85 years and older were reviewed. Outcomes including indications, complications, diagnostic yield, and final diagnosis were compared with a control group consisting of patients' ages of 65 to 79 years old. RESULTS: Seventy-three bronchoscopies were performed in each group. The mean age of the older group was 87.1±2.6 years, and had a higher American Society of Anesthesiology (ASA) class than the younger group (P=0.03). There were no significant differences in the indications for bronchoscopy (P>0.05), sampling performed (P>0.05), complication rates (P>0.05), diagnostic yield (P>0.05), or final diagnoses (P>0.05). Similar proportions of each group with a malignancy diagnosis received some form of therapy (P>0.05), although fewer of the older group underwent surgery (P=0.03). Analysis of the cohort demonstrated that ASA class 3 to 4 was associated with increased rate of complications and use of anesthesia compared with lower ASA class (P<0.02). CONCLUSION: FB in the elderly demonstrated no differences in procedural complications, diagnostic yield, and utility of the procedure for an underlying diagnosis. This study suggests bronchoscopy is as safe and useful in the very elderly as a population of the age of 65 to 79.
Asunto(s)
Broncoscopía/métodos , Tecnología de Fibra Óptica/instrumentación , Enfermedades Pulmonares/diagnóstico por imagen , Neoplasias/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Broncoscopía/efectos adversos , Broncoscopía/normas , Femenino , Humanos , Incidencia , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/patología , Masculino , Neoplasias/patología , Neoplasias/terapia , Estudios RetrospectivosRESUMEN
Excessive dynamic airway collapse is a relatively new diagnosis separate from tracheobronchomalacia that is manifested by functional collapse of the large airways. Most commonly described in patients with underlying obstructive lung disease such as chronic obstructive pulmonary disease and asthma, it may contribute to increased dyspnea, cough, or exacerbations. There are few data published on the role of excessive dynamic airway collapse as related specifically to exercise. It was recently described as the cause for exertional dyspnea in individuals without underlying lung disease.