Pulmonary Procedures |

Survey on Physicians Attitude Concerning Flexible Bronchoscopy in the Very Elderly FREE TO VIEW

Mario Christianto; Nazia Sultana; Thomson Pancoast; Mark Bowling
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East Carolina University, Greenville, NC

Chest. 2014;146(4_MeetingAbstracts):730A. doi:10.1378/chest.1993767
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SESSION TITLE: Bronchoscopy Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Flexible bronchoscopy is safe and well tolerated in the elderly, but attitudes of pulmonologists toward performing this procedure in the very elderly (> 85 years) is unknown. We performed a survey to investigate pulmonary specialist beliefs about bronchoscopy in this age group

METHODS: 1,744 pulmonary specialists (identified by membership in the American College of Chest Physicians) were surveyed via e-mail about their opinions regarding bronchoscopy in the elderly. The physicians were asked to complete an 11-question multiple-choice online survey

RESULTS: Two hundred thirty five (235) pulmonologists responded and 228 (13.07%) completed the survey. Most {91% (209)} report that age is not a barrier to bronchoscopy. Additionally, 64% (147) responded that severe COPD, lung fibrosis, and heart failure in the very elderly is not a contraindication for bronchoscopy. The majority 73% (145) does not require any routine prebronchoscopic testing. In terms of procedural complications most felt that there was not an increase risk of pneumothoraces 91% (205), bleeding 90.2% (203), or the likelihood of death 71% (159) in those older than 85 years. However, 51% (114) reported that hypotension and 61% (137) that hypoxia is more common in this age group. Ninety two percent (209) of those surveyed felt that less sedation is required for the procedure and 72% (165) report moderate sedation as the best choice. Less than half 47% (108) responded that the very elderly tolerate bronchoscopy as well as younger patients. The majority {93% {209)} reported they would recommend bronchoscopy for tissue diagnosis of suspected early stage lung cancer in those very elderly patients with a good functional status and 66% (149) would do the procedure in these patients with late stage lung cancer and an adequate functional status

CONCLUSIONS: In this limited survey lung specialist do not view age as a barrier for flexible bronchoscopy and their beliefs in terms of comorbidity, tolerance, sedation and adverse events of the procedure are consistent with those that are reported in the literature for the elderly. Most agree that bronchoscopy should be offered as a tool for diagnosing lung cancer in the very elderly with a good functional status but the potential stage of the cancer plays a secondary role in the decision-making process

CLINICAL IMPLICATIONS: It will be interesting to see why some pulmonologists feel that flexible bronchoscopy is not an option in the very elderly with good functional status and potentially treateable disease

DISCLOSURE: The following authors have nothing to disclose: Mario Christianto, Nazia Sultana, Thomson Pancoast, Mark Bowling

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