On the Endoscopic Methods Used with Questionable Indications

This letter is a continuation of the series of reports on invasive procedures applied in the former Soviet Union (SU) with questionable clinical indications, also for research [1-4]. The problem is still with us: partial isolation from the international scientific community resulting in persistence of suboptimal practices. In this letter, special attention is given to the bronchoscopy (Bs) in bronchial asthma, used in spite of the widespread opinion that it brings not much benefit [5]. In the international literature, no particular role of Bs in the diagnosis and treatment of asthma has been specified, asthmatics being regarded at enhanced risk for complications from this procedure [5]. Among indications for Bs in asthma are persistent wheeze unresponsive to bronchodilators and other adequate therapy [6,7]. While there are other diagnostic tests, the most common indication for Bs in asthma is a search for alternative causes of the symptoms [6]. Lavage of bronchi can be indicated in severe asthma in certain circumstances [8,9]. More precise formulations are avoided here because this letter is not an instructive publication. The newest Russian-language textbooks are largely based on the international literature. However, earlier textbooks and manuals contained recommendations partly at variance with internationally accepted approaches. In asthmatics, the purpose of Bs was declared to be the search for signs of dependence of the pathological process on the infection and characterization of inflammatory lesions [10,11]. Abundant secretion or mucopurulent sputum in a child was presented as an indication for Bs “for evaluation of the endobronchial inflammation” [12]. It was stated in the instructive monograph [11] that in children Bs is recommended “almost in all subacute and chronic respiratory diseases”. Asthma, tuberculosis (Tb), bronchitis, and protracted pulmonary or bronchial conditions in general, were posited as indications for Bs [13-18].