“Reliable tests with a high negative predictive value can help to defer non-COVID patients to a normal ward without isolation and preserve isolation rooms for COVID-19 patients,” said Dr Thomas Malfait (Ghent University Hospital, Belgium). Thus, clinicians are in need of fast and reliable diagnostic results. The current gold-standard for confirmation of a suspected COVID-19 infection is a real-time reverse transcriptase-polymerase chain reaction (rRT-PCR), and specimens taken by bronchoalveolar lavage (BAL) show the highest rate of positivity in rRT-PCR [2,3]. However, recommendations have been in favour of postponing bronchoscopy to protect healthcare workers. Due to this advice, the diagnostic value of bronchoscopy in this setting is not yet known. Thus, Dr Malfait and his fellow investigators retrospectively evaluated the results of video bronchoscopies performed between 19 March and 5 May 2020.
The added diagnostic certainty was classified as: alternative microbiological diagnosis in the BAL fluid or SARS-CoV-2 PCR positivity or negativity in BAL fluid. The indication for performing video bronchoscopies was a diagnostic uncertainty in patients that had repetitive negative PCR swabs but high clinical indicators of COVID-19 and a positive chest CT (n=31), or COVID-19 positive patients (n=7) with suspected alternative pathologies such as a superinfection.
The results for the first group showed rRT-PCR positivity in 7 cases, 9 patients that were truly negative (i.e. negative rRT-PCR) and 15 alternative microbiological diagnoses. In the group of COVID-19 positive patients, an additional microbiological diagnosis was detected in 5 out of 7 cases. Taken together, 95% of the 38 bronchoscopies resulted in additional diagnostic certainty. All video bronchoscopies were performed on haemodynamically stable or ventilated patients, using personal protection equipment, preferably as bedside procedure. There were no bronchoscopy-related adverse events, nor COVID-19 infections in involved staff.
“In suspected COVID-19 cases with diagnostic uncertainty, bronchoscopy has an additional diagnostic value with therapeutic consequences, provided safety standards are ensured. There is a high yield in alternative diagnoses and the negative predictive value for contagiousness seems to be high,” concluded Dr Malfait.
- Malfait T, et al. The role of bronchoscopy in COVID-19 patients during the SARS-CoV-2 pandemic. LBA 4146, ERS International Virtual Congress 2020, 7-9 Sept.
- European Centre for Disease Prevention and Control. June 2020. Retrieved from: https://www.ecdc.europa.eu/en/covid-19/latest-evidence/diagnostic-testing [Accessed on 30 Sept 2020].
- Wang W, et al. JAMA. 2020;323:1843-1844.
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Table of Contents: ERS 2020
Featured articles
COVID-19 and the Lung
COVID-19 infections: Bronchoscopy provides additional diagnostic certainty
COVID-19 vaccines: An ongoing race
COVID-19: What is the risk of reinfection?
COVID-19 App: The Dutch experience
Secondary pulmonary fibrosis: a possible long-term effect of severe COVID-19
COVID-19 survivors benefit from structured follow-up
Early pulmonary rehabilitation post-COVID-19 aids recovery
Asthma – What's New
Mild asthma: A fundamental change in management
Dupilumab shows long-term efficacy in asthma patients
Severe asthma: Oral corticosteroids maintenance therapy associated with toxicity
First-in-class tyrosine kinase inhibitor shows promise in severe asthma
Predicting individual effectiveness of biologics in severe asthma
IL-5 antagonist showed efficacy in chronic rhinosinusitis with nasal polyps
Treatment according to genotype: The future of asthma therapy?
COPD – The Beat Goes On
The role of chronic symptoms as early biomarkers of COPD development
Urgent call for studies in COPD patients aged 40-60 years
Nasal high-flow therapy: a novel treatment option for hypercapnic COPD patients
Exacerbation history is a reliable predictor of future exacerbations
Singing training effective as physical rehabilitation in COPD
Current prediction tools underestimate exacerbation risk of severe COPD patients
Exercise and Sleep: From Impaired Function to New Therapeutic Strategies
CPAP withdrawal has negative consequences for sleep apnoea patients
Physical activity improves AHI in sleep apnoea patients
The Tobacco Epidemic: From Vaping to Cannabis
Poly-use of nicotine products and cannabis: a deadly combination
E-cigarettes: A source of chronic lung inflammation
Social smoking: Do not underestimate the risks
Chronic Cough – State of the Art
LEAD study shows multiple phenotypes in many chronic cough patients
First-in-class P2X3 receptor antagonist shows promise for chronic cough treatment
Lung Cancer Detection
Lung cancer screening: Most patients not eligible 1-2 years prior to diagnosis
Distinct changes in lung microbiome precede clinical diagnosis of lung cancer
Best of Posters
Smartphone-based cough detection helpful in predicting asthma deterioration
Reduced lung function associated with cognitive decline in the elderly
Longer hospital stay and fewer transplants for frail ILD patients
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