#00016Bronchoscopic practices in adult Cystic Fibrosis at Cork University Hospital 2012-2022: Increased usage, new Indications and the emergence of single-use flexible bronchoscopy.

Deasy ¹, Ibrahim ¹, Fleming ¹, Mc Carthy ¹, Dorgan ¹, Mc Carthy ¹, Twohig ¹, O'Regan ², Kirwan ², Henry ³, Kennedy ³, Murphy ³, Plant ¹.

¹Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital - Cork (Ireland), ²Cystic Fibrosis Registry of Ireland, Woodview House, University College Dublin - Dublin (Ireland), ³Department of Respiratory, Cork University Hospital - Cork (Ireland).

Abstract

In paediatrics, bronchoscopy is often used in patients-with-cystic-fibrosis (PWCF) for microbiological assessment. In adults this has not been routinely necessary.

A retrospective review of medical records between 2012-2022 was performed on all adult PWCFs attending the service (n=223) to identify those attending for bronchoscopy. Demographics, baseline metrics, indication and outcome were recorded.

69 bronchoscopies were performed, representing 56 unique patients, including 9 (16%) post-lung-transplant. At time of procedure, mean FEV1 (% pred.) increased from 60% (2012-14) to 71% (2021-22) and age from 30 to 36 years. There was an increase in bronchoscopies with a mean of 6 per-annum (2012-19), compared with 13 in 2021, and 7 year-to-date 2022. Figure 1 highlights the changing indications. Since 2019, bronchoscopy as a primary tool to assess airway culture has emerged, with all bronchoscopes changing to single-use-flexible-bronchoscopes (SUFB) since 2021. 78.9% (n=15/19) of SUFB patients were culture positive compared with 83.7% (n=41/49) of reusable bronchoscopes.

Increased usage and changing indications for bronchoscopy is probably explained by a reduction in sputum production as a consequence of increasing CFTR modulation. The emergence of SUFBs allows analysis which avoids cross-contamination and sample contamination.

[figure1]