No oral corticosteroids before a confirmed diagnosis of ILD

Data from a Finnish study assessing the pre-operative risk factors for transbronchial lung cryobiopsy (TBLC) complications in patients with interstitial lung disease (ILD) showed that patients should refrain from oral corticosteroids before a confirmed diagnosis. Also, severe cough should be considered before TBLC is considered.

Not much is known about the pre-operative risk factors associated with TBLC complications. Therefore, a study evaluating the pre-operative risk factors of clinically relevant complications of TBLC in patients with ILD was initiated [1]. Apart from complication rates, the study also aimed to describe the Finnish TBLC procedure and to report the diagnostic yield of the procedure.

Between January 2015 and December 2019, 100 patients (60 men) with a median age of 66.1 years were recruited from two Finnish hospitals (Kuopio University Hospital and Tampere University Hospital). The inclusion criteria consisted of a referral for a suspected ILD and a requirement of a histological investigation to confirm the diagnosis. Patients with a BMI >30 kg/m², a history of an acute myocardial infarction or another acute or untreated cardiovascular disease, or active tuberculosis were excluded from the study, as were patients who were on anticoagulation treatment that could not be withheld, and those with abnormal bleeding history or abnormal clotting parameters. High-resolution CT (HRCT) scans and Leicester Cough Questionnaire were obtained before the TBLC; current medication use (including oral corticosteroid use within 30 days before the TBLC) was recorded. TBLC and bronchoalveolar lavage (BAL) were performed in an operating room in an outpatient setting and the obtained samples were subsequently analysed. Following the procedures, of the 100 participants, 68 had no or only mild complications, whereas 32 experienced clinically significant complications (i.e. clinically significant bleeding and/or pneumothorax, ICU admission or death within 90 days). Two patients died within 90 days of the procedures (suspected acute exacerbation of ILD, acute cardiac arrest); none of the patients died within 30 days of the procedures.

The diagnoses were concluded in a multidisciplinary meeting. The diagnostic yield was 87% and interobserver agreement on honeycombing was ᴋ=0.66, on emphysema ᴋ=0.70, and on traction bronchiectasis ᴋ=0.44. Regarding (post-operative) complications: a history of severe cough was associated with pneumothorax; also oral corticosteroid use within 30 days of the TBLC seemed to associate with complications. According to the researchers, limitations of the study include a rather small population and the use of the backward stepwise elimination method which can be considered hypothesis-generating. However, the covariates in this model were carefully selected before the analysis to increase the reliability of the model and to reduce noise variables [1,2].

1. Momonen M, et al. Resp Med. 2022;200:106922.
2. Mononen M. Risk factors associated with clinically significant complications in transbronchial lung cryobiopsy in ILD patients. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

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