Looking Inside: Lung Imaging and Bronchoscopy for Asthma

My severe asthma journey took on many wild twists and tales. Receiving and asthma diagnosis was an adventure, and there were a lot of diagnostics that went into it.

Looking inside my lungs

I specifically remember when I was going through a period of significant exacerbation and nothing seemed to be working. I just felt like I wanted to have my mucus sucked out of me. It is my understanding that therapeutic bronchoscopies are very seldom done in this day and age, but I was dying for a look inside my lungs. I know it sounds strange, but I wanted to know why they were being so goofy. Are they completely full of mucus?

This had me thinking of a couple of things; how useful is imaging in asthma, and when is a therapeutic bronchoscopy actually warranted? Here is what my research revealed.

Imaging for asthma

• The imaging modalities that may be used in asthma are x-rays (radiography), CT scans, MRIs, and PET scans. In some circumstances and an area where more research may be needed is the use of endobronchial ultrasound (EBUS) and optical coherence tomography (OCT). These modalities still require standards to be determined.¹
• Clinical diagnosis of asthma may use imaging findings; however, it is largely dependent on history, physical exam features, and pulmonary function testing (PFT). There is hope that imaging biomarkers can be established and implemented in the diagnosis of asthma.
• Lung structure (bronchial wall thickening), ventilation defects, and air trapping are just some of the findings that have been associated with asthma.
• Fun fact: The effects of inhaled steroids on air trapping has been observed on CT scans!¹

Investigational bronchoscopy use in asthma

• This is often used to have a look around and obtain fluids. Fluids are often obtained through bronchoalveolar lavage (BAL). The fluids are then analyzed to identify pathogens.
• Bronchoalveolar lavage fluid samples can best tested for total cell counts, macrophages, lymphocytes, eosinophils, neutrophils and epithelial cells.
• There is currently a lack of safety data for its role in severe asthmatics. Doctors usually ensure this procedure is only carried out when you are stable enough and when valuable information is likely to be gained.
• Investigational bronchoscopies can be used to rule out asthma masqueraders.
• Fun fact: I had a mucus impaction treated through an investigational bronchoscopy. There was a concern that they would not be able to complete my bronchoscopy, but ultimately were able to.

Should I get a bronchoscopy for asthma now?

While I am not 100% sure if my airways are filled with a high volume of mucus, I am hoping to find out at an upcoming follow-up appointment. Ironically, I am keeping my fingers crossed for imaging to happen at this appointment. There are currently very few treatment options available for mucus hypersecretion and the chances of me being able to get a therapeutic bronchoscopy to suck out my mucus are slim to none. It is better to treat the production of the mucus than just making it go away. Although, there are days in which I do just want it to go away.

Have you had an experience with lung imaging for your asthma? Have you had a bronchoscopy as part of your diagnosis? If so, I would love to hear about your experience in the comments below!