ABSTRACT
Fibreoptic bronchoscopy is an important diagnostic and therapeutic tool for a wide spectrum of thoracic disorders in interventional pulmonology. The British Thoracic Society published comprehensive guidelines in 2001 on the use of fibreoptic bronchoscopy. The purpose of this audit was to evaluate the performance of our bronchoscopy service in the light of these guidelines with a view to identify areas for further improvement. In this prospective audit a series of 50 consecutive bronchoscopies performed at KRL Hospital Islamabad was studied. For each examination we recorded patient demographics, indication of the procedure, radiological information, pre-procedure evaluation by the pulmonologist, the bronchoscopic appearance and histopathological and microbiological findings, where indicated, and any untoward events associated with the procedure. The mean age was 48.8yrs [SD +/- 17.9] with male predominance [M 78%, F 22%].The main indication of the procedure was sampling of bronchial washings for microbiological assessment [n=25; 50%], followed by evaluation of suspected malignancy[n=15; 30%], hemoptysis [n=9; 18%] and persistent cough [n=1; 2%]. Chest X-rays were abnormal in majority of patients [n=46; 92%] and radiological appearance of pulmonary mass lesion was seen in 24% [n=11] of abnormal CXRs. Thirty percent [n=15] of bronchoscopies were abnormal with 93% diagnostic yield of specimens obtained for histopathological assessment. A low diagnostic yield of 24% was observed in cases of specimens collected for microbiological assessment. No major procedure related complications were observed during or after the procedures. Fibreoptic bronchoscopy is a safe procedure provided all basic precautions are taken. The procedure should be considered in all patients with a mass lesion on CXR. Although thehistopathological diagnostic yield was well above the recommended standard in cases of endoscopically visible malignancy but a low diagnostic microbiological yield was observed especiallyin cases being evaluated for tuberculosis. The latter may be attributed to less selective study population and sub-optimal microbiological service. Hence the audit was useful in identifying an area for furtherimprovement. In a developing country, like Pakistan, gender bias is rampant even when it comes to access the healthcare facilities