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Correspondence |

Use of Antisialogogues in Bronchoscopy FREE TO VIEW

Clayton T. Cowl, MD, FCCP
Author and Funding Information

From the Mayo Clinic and the Mayo Medical School.

Correspondence to: Clayton T. Cowl, MD, FCCP, Mayo Clinic, 200 First St SW, Baldwin 5A, Rochester, MN 55905; e-mail: cowl.clayton@mayo.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):738. doi:10.1378/chest.09-2187
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To the Editor:

In their recent article in CHEST (August 2009), Malik et al 1 suggest that use of anticholinergic premedication may reduce airway secretions during bronchoscopy but not cough, patient discomfort, oxygen desaturation, or procedure time. However, a review of their data does not truly support a clinically important difference, even for secretion reduction.

We found the design of their study to be strikingly similar to our initial randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate published in 2000 within this same journal (July 2000).2 The only real difference between our study and the Malik study published 9 years later was the total number of patients enrolled; in fact, the findings are nearly identical. We designed our initial study to have 80% statistical power (β) of detecting a 12% difference between the mean values recorded on a visual analog scale for the primary end point of control of respiratory tract secretions. This difference was estimated to be the minimum required to make the use of these medications clinically important. To achieve this level of power, approximately 210 patients were calculated to have been required for the study, 70 in each group. Although Malik and colleagues enrolled 1,000 consecutive patients who were eligible, they unfortunately did not report the level of statistical power to which they designed their study. If they did, one would likely see that the minimal difference in visual analog scale scores reported was barely statistically significant, and hardly clinically generalizable.

In summary, there is now a multitude of published data demonstrating that administration of antisecretory drugs prior to bronchoscopy does not reduce procedure times, does not result in clinically significant differences in cough or secretion control, and in some cases may actually result in clinical harm. Its routine use should be abandoned.

Malik JA, Gupta D, Agarwal AN, Jindal SK. Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate. Chest. 2009;1362:347-354. [CrossRef] [PubMed]
 
Cowl CT, Prakash UBS, Kruger BR. The role of anticholinergics in bronchoscopy. A randomized clinical trial. Chest. 2000;1181:188-192. [CrossRef] [PubMed]
 

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References

Malik JA, Gupta D, Agarwal AN, Jindal SK. Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate. Chest. 2009;1362:347-354. [CrossRef] [PubMed]
 
Cowl CT, Prakash UBS, Kruger BR. The role of anticholinergics in bronchoscopy. A randomized clinical trial. Chest. 2000;1181:188-192. [CrossRef] [PubMed]
 
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