Complications and safety analysis of diagnostic bronchoscopy in COPD: a systematic review and meta-analysis

Chronic obstructive pulmonary disease (COPD) often coexists with many diseases that require bronchoscopy. We conducted this systematic review and meta-analysis to assess the safety and complication rate of diagnostic bronchoscopy in patients with COPD. We retrieved clinical trials that reporting the complications of conducting diagnostic bronchoscopy on patients with COPD through electronic databases. Analyses of the overall major complication rate of bronchoscopy and potential risk factors in patients with COPD were conducted. 18 trials/arms were evaluated. The overall major complication rate of bronchoscopy was 4.3% (95% CI, 2.2%-8.2%; 18 trials/arms, n = 2000). The major complication rate of the patients with an exacerbation of COPD was higher than that of the stable patients (7.8% vs. 4.5%, Q-value = 11.29, df (Q) = 1, <i>p</i> &lt; 0.01); using of sedative medicine was also related with higher major complication rate (Q-value = 6.303, df (Q) = 2, <i>p</i> = 0.043). Patients with severe COPD who were GOLD stages III and IV (Q = 13.40, df = 1, <i>p</i> &lt; 0.01; R² = 0.66) or had a high BMI (Q = 30.83, df = 1, <i>p</i> &lt; 0.01; R² = 0.91) more easily encountered complications during bronchoscopy. The major complication rate of diagnostic bronchoscopy in patients with COPD was acceptable and low Exacerbations of COPD and using sedative medicine were related with higher major complication rate. COPD is a major risk factor for lung cancer and infection, so the patients with COPD often required bronchoscopy. Although our results showed diagnostic bronchoscopy might not be more fatal for patients with COPD, further studies are needed to explore the potential risk factors for major complications of bronchoscopy in patients with COPD.

慢性阻塞性肺疾病（Chronic obstructive pulmonary disease, COPD）常与多种需行支气管镜检查的疾病共存。我们开展此项系统评价与荟萃分析，旨在评估慢性阻塞性肺疾病患者接受诊断性支气管镜检查的安全性及并发症发生率。我们通过电子数据库检索了报道慢性阻塞性肺疾病患者行诊断性支气管镜检查并发症的临床试验，并对支气管镜检查的总体严重并发症发生率及慢性阻塞性肺疾病患者的潜在危险因素进行了分析，共纳入18项试验/亚组进行评估。结果显示，支气管镜检查的总体严重并发症发生率为4.3%（95%置信区间[CI]：2.2%~8.2%；18项试验/亚组，n=2000）。慢性阻塞性肺疾病急性加重期患者的严重并发症发生率高于稳定期患者（7.8% vs. 4.5%，Q值=11.29，自由度df(Q)=1，p<0.01）；使用镇静药物也与更高的严重并发症发生率相关（Q值=6.303，df(Q)=2，p=0.043）。此外，GOLD分级为Ⅲ、Ⅳ级的重度慢性阻塞性肺疾病患者（Q=13.40，df=1，p<0.01；R²=0.66）或高BMI患者（Q=30.83，df=1，p<0.01；R²=0.91）在支气管镜检查过程中更易出现并发症。慢性阻塞性肺疾病患者行诊断性支气管镜检查的严重并发症发生率处于可接受的较低水平，慢性阻塞性肺疾病急性加重及使用镇静药物与更高的严重并发症发生率相关。慢性阻塞性肺疾病是肺癌与感染的主要危险因素，因此慢性阻塞性肺疾病患者常需行支气管镜检查。尽管本研究结果显示诊断性支气管镜检查对慢性阻塞性肺疾病患者可能并非致命性操作，但仍需开展进一步研究以探讨慢性阻塞性肺疾病患者支气管镜检查严重并发症的潜在危险因素。