Transbronchial lung cryobiopsy in asthmatic patients: is it useful?

Introduction: Lung biopsy in asthmatic patients is justified in case of atypical presentations of asthma, when other differential diagnoses such as hypersensitivity pneumonitis or Churg-Strauss syndrome could be possible, or for research purposes. Aim: We aim to describe the safety of TBLC (transbronchial lung cryobiopsy) in asthmatic patients and to provide data on the pathological changes occurring in the alveolar spaces. Methods: We reviewed patients suspected for DPLDs (diffuse parenchymal lung diseases) who underwent TBLC and eventually had a diagnosis of asthma. Results: Three patients with a final diagnosis of asthma were detected. Two had severe asthma, since the disease remained poorly controlled despite the maximization of therapy. Pathological abnormalities in severe asthma were goblet cell metaplasia, eosinophilic infiltration of mucosa and submucosa and thickening of the lamina basalis in the bronchial wall; in the peribronchiolar spaces, lymphocytic and eosinophilic inflammation; interstitial lymphocytic and eosinophilic inflammation in the alveolar spaces. Those changes were already well identified with surgical lung biopsy (SLB). Pathological changes in non-severe asthma were: peribronchial nodular lymphoid inflammation and one non-necrotizing granuloma; scattered eosinophils and no inflammation in the alveolar spaces. No complications reported. Conclusions: We suggest the potential role of TBLC in asthmatic patients. Its safety and its diagnostic accuracy lead to consider TBLC instead of SLB when histological changes are needed for differential diagnoses. TLBC could be also useful for research in the pathobiology of asthma and severe asthma.