Am. J. Respir. Crit. Care Med., Volume 162, Number 2, August 2000, 440-445

Predictors of Pain Control in Patients Undergoing Flexible Bronchoscopy

NOAH LECHTZIN, HAYA R. RUBIN, MOLLIE JENCKES, PETER WHITE Jr., LI-MING ZHOU, DAVID A. THOMPSON, and GREGORY B. DIETTE

Divisions of Pulmonary and Critical Care Medicine, School of Medicine, Departments of Epidemiology and Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland; and University of Arkansas for Medical Sciences, Little Rock, Arkansas

The purpose of this study was to assess the extent to which patients undergoing flexible bronchoscopy (FOB) experience pain and to identify patient factors and process of care factors that are associated with pain. We conducted a prospective cohort study on 481 patients undergoing FOB. Overall control of pain during FOB was the primary outcome. The mean age of the patients was 48 yr, 50% were male, and 32% required supplemental oxygen prior to FOB. Pain control was excellent in 36% of patients, but 10% considered it to be fair or poor. Patient factors associated with excellent pain control were excellent health (versus poor health, OR = 6.25 [95% CI, 2.28-16.67]), more education (college education versus high school education, OR = 1.72 [95% CI, 1.05-2.86]), and not having asthma (OR = 2.86 [95% CI, 1.09-7.14]). Process of care factors associated with excellent pain control were not being bothered by scope insertion (versus bothered, OR = 3.65 [95% CI, 1.99-6.98]), no memory of FOB (versus some memory, OR = 2.33 [95% CI, 1.24-4.44]), and higher ratings of information about the procedure (per 1-point increase on a 12-point scale, OR = 1.57 [95% CI, 1.41-1.78]). This is the first large-scale, prospective study to evaluate patient and process of care factors that influence pain control during FOB. It demonstrated that there are patient characteristics and process of care factors that need to be considered when evaluating pain during bronchoscopy. Improved preparation of patients with lower education, inferior health status, and asthma may lead to decreased pain during FOB. Bronchoscopists may be able to reduce pain during FOB by identifying methods to decrease pain on scope insertion, by improving the information provided to patients, and by achieving greater levels of amnesia during FOB.

This article has been cited by other articles:

				K. Atassi, G. Mangiapan, C. Fuhrman, S. Lasry, P. Onody, and B. Housset Prefixed Equimolar Nitrous Oxide and Oxygen Mixture Reduces Discomfort During Flexible Bronchoscopy in Adult Patients: A Randomized, Controlled, Double-Blind Trial Chest, August 1, 2005; 128(2): 863 - 868. [Abstract] [Full Text] [PDF]

				R. J. Lenox A Proper Balance Chest, January 1, 2004; 125(1): 13 - 14. [Full Text] [PDF]

				B. Fauroux, P. Onody, O. Gall, B. Tourniaire, S. Koscielny, and A. Clement The Efficacy of Premixed Nitrous Oxide and Oxygen for Fiberoptic Bronchoscopy in Pediatric Patients: A Randomized, Double-Blind, Controlled Study Chest, January 1, 2004; 125(1): 315 - 321. [Abstract] [Full Text] [PDF]

				J. Pickles, M. Jeffrey, A. Datta, and A.A. Jeffrey Is preparation for bronchoscopy optimal? Eur. Respir. J., August 1, 2003; 22(2): 203 - 206. [Abstract] [Full Text] [PDF]

				R Booton, M Jones, and N Thatcher Lung cancer * 7: Management of lung cancer in elderly patients Thorax, August 1, 2003; 58(8): 711 - 720. [Full Text] [PDF]

				G. B. Diette, N. Lechtzin, E. Haponik, A. Devrotes, and H. R. Rubin Distraction Therapy With Nature Sights and Sounds Reduces Pain During Flexible Bronchoscopy: A Complementary Approach to Routine Analgesia Chest, March 1, 2003; 123(3): 941 - 948. [Abstract] [Full Text] [PDF]

				A. C. Mehta Don't Lose the Forest for the Trees: Satisfaction and Success in Bronchoscopy Am. J. Respir. Crit. Care Med., November 15, 2002; 166(10): 1306 - 1307. [Full Text] [PDF]

				N. Lechtzin, H. R. Rubin, P. White Jr., M. Jenckes, and G. B. Diette Patient Satisfaction with Bronchoscopy Am. J. Respir. Crit. Care Med., November 15, 2002; 166(10): 1326 - 1331. [Abstract] [Full Text] [PDF]

				M. J. TOBIN Sleep-disordered Breathing, Control of Breathing, Respiratory Muscles, Pulmonary Function Testing, Nitric Oxide, and Bronchoscopy in AJRCCM 2000 Am. J. Respir. Crit. Care Med., October 15, 2001; 164(8): 1362 - 1375. [Full Text] [PDF]