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Interventional pulmonology techniques in elderly patients with comorbidities

  • Michele Mondoni
    Correspondence
    Corresponding author at: Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano; Via Di Rudinì n. 8, 20142 Milan, Italy.
    Affiliations
    Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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  • Dejan Radovanovic
    Affiliations
    Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Milan, Italy

    Division of Respiratory Diseases, “Luigi Sacco” University Hospital; ASST Fatebenefratelli-Sacco, Milan, Italy
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  • Giovanni Sotgiu
    Affiliations
    Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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  • Fabiano Di Marco
    Affiliations
    Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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  • Paolo Carlucci
    Affiliations
    Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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  • Stefano Centanni
    Affiliations
    Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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  • Pierachille Santus
    Affiliations
    Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Milan, Italy

    Division of Respiratory Diseases, “Luigi Sacco” University Hospital; ASST Fatebenefratelli-Sacco, Milan, Italy
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Published:September 29, 2018DOI:https://doi.org/10.1016/j.ejim.2018.09.015

      Highlights

      • Bronchoscopy is effective and safe in the management of chest diseases in the elderly.
      • A similar complication rate of bronchoscopy between younger and older patients exists.
      • A limited number of adverse events related to sedation are described in the elderly.

      Abstract

      Respiratory diseases are common cause of disability in the elderly and are often concomitant with other non-respiratory medical conditions. Interventional pulmonology includes advanced diagnostic and therapeutic techniques, successfully employed for benign and malignant pulmonary diseases with a good safety profile.
      A few studies are available on the efficacy and the safety of these procedures (both bronchoscopic and pleural techniques) in the elderly. Paucity of data in these patients may support reluctant clinicians.
      We carried out a non-systematic review aimed at describing the scientific literature on interventional pulmonology techniques in elderly patients with comorbidities.
      We summarized indications, performance characteristics, and safety profile of bronchoscopic techniques in the elderly, comparing outcomes between older and younger patients. We explored the role of age on anesthesia and sedation protocols during endoscopic procedures and assessed the influence of comorbidities on bronchoscopic outcomes.
      This review underlines that older age is not a barrier for implementing interventional pulmonology for diagnostic and therapeutic purposes.

      Keywords

      Abbreviations:

      IP (interventional pulmonology), BW (bronchial washing.), BAL (bronchoalveolar lavage.), BB (bronchial biopsy.), TBB (transbronchial biopsies.), TBNA (transbronchial needle aspiration.), EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration.), EGFR (epidermal growth factor receptor.), ROSE (rapid on-site evaluation.), TB (tuberculosis.), COPD (chronic obstructive pulmonary disease.), EUS-B-FNA (endoscopic ultrasound with bronchoscope needle aspiration.), ASA (American Society of Anesthesiologists.), SD (standard deviation.)
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