The Relationship Between Age and Process of Care and Patient Tolerance of Bronchoscopy

Authors


Address correspondence to Gregory B. Diette, MD, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St., Baltimore, MD 21205. E-mail: gdiette@jhmi.edu; bhehn1@hfhs.org

Abstract

OBJECTIVES: To determine whether patient age is associated with differences in flexible bronchoscopy technique and tolerance.

DESIGN: Prospective cohort study.

SETTING: University hospital system.

PARTICIPANTS: One thousand three hundred fifty-eight adults, including 219 (16.1%) aged 70 and older, undergoing bronchoscopy.

MEASUREMENTS: Indications, sampling procedures, medication doses, patient reports of pain, willingness to return, and adverse events associated with bronchoscopy.

RESULTS: Indications for bronchoscopy varied with age, with solitary pulmonary nodule (P < .001), mass (P < .001), or lymphadenopathy (P < .001) being more common in older patients. Invasive sampling methods were used more often with increasing age, but variation in disease processes between age groups accounted for the difference in sampling method performed. Mean doses of midazolam and fentanyl given for sedation decreased with increasing age (P < .001). There was no significant difference between older and younger patients in reported very good to excellent pain control (50% of patients ≥70 vs 64% of patients <40; P = .56) or in willingness to return for repeat bronchoscopy (98% vs 92%, respectively; P = .324). Overall risk for an adverse event increased with increasing patient age (P < .01), but adverse events were uncommon and generally not severe. Hypotension and pneumothorax were rare but occurred more often in older persons (1.9% and 3.4% in patients ≥70 vs 0.5% and 0.7% in patients <40, respectively).

CONCLUSION: Despite more-invasive sampling methods and less sedation during bronchoscopy, elderly patients tolerate bronchoscopy as well as younger patients. There is increased risk for adverse events with increasing age, but the absolute frequency is low, suggesting that chronological age should not be a contraindication for bronchoscopy in older persons.

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