PULMONARY PATHOLOGIES AND MANAGEMENT STRATEGIES IN PRIMARY IMMUNODEFICIENCIES

pulmonary_pathologies_kapak

THE UTILITY OF BRONCHOSCOPY AND PULMONARY SURGERY IN THE MANAGEMENT OF PRIMARY IMMUNODEFICIENCIES

Filiz Sadi Aykan1
Semra Demir2

1University of Health Sciences, Gülhane Training and Research Hospital, Faculty of Medicine, Department of Immunology and Allergic Diseases, Ankara, Türkiye
2İstanbul University, Faculty of Medicine, Department of Immunology and Allergic Diseases, İstanbul, Türkiye

Sadi Aykan F, Demir S. The Utility of Bronchoscopy and Pulmonary Surgery in the Management of Primary Immunodeficiencies. In: Arslan Ş editor. Pulmonary Pathologies and Management Strategies in Primary Immunodeficiencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.129-139.

ABSTRACT

In primary immunodeficiency, managing lung pathologies often requires a strategic approach. Bronchoscopy serves as a crucial diagnostic tool, with its effectiveness maximized through early intervention. Surgical interventions, ranging from resection of localized infections to lung transplantation for end-stage disease, are considered when medical and less invasive managements fail. These decisions necessitate a multidisciplinary evaluation, balancing the potential benefits against the heightened risks associated with immunocompromised patients. This review will present an overview of the diagnostic approaches and management strategies for pulmonary complications in primary immunodeficiencies, followed by a discussion on the utility of bronchoscopy and pulmonary surgical interventions.

Keywords: Primary immunodeficiency; Lung disease; Bronchoscopy; Pulmonary surgical procedures

Referanslar

  1. Morton C, Puchalski J. The utility of bronchoscopy in immunocompromised patients: a review. J Thorac Dis. 2019;11:5603-12. [Crossref]  [PubMed]  [PMC]
  2. Grenier PA, Brun AL, Longchampt E, Lipski M, Mellot F, Catherinot E. Primary immunodeficiency diseases of adults: a review of pulmonary complication imaging findings. Eur Radiol. 2024;34:4142-54. [Crossref]  [PubMed]  [PMC]
  3. Casal A, Riveiro V, Suarez-Antelo J, Ferreiro L, Rodriguez-Nunez N, Lama A et al. Pulmonary Manifestations of Primary Humoral Deficiencies. Can Respir J. 2022;2022(1):7140919. [Crossref]  [PubMed]  [PMC]
  4. Dhalla F, Lochlainn DJM, Chapel H, Patel SY. Histology of Interstitial Lung Disease in Common Variable Immune Deficiency. Front Immunol. 2020;11:605187. [Crossref]  [PubMed]  [PMC]
  5. Bierry G, Boileau J, Barnig C, Gasser B, Korganow AS, Buy X et al. Thoracic manifestations of primary humoral immunodeficiency: a comprehensive review. Radiographics. 2009;29:1909-20. [Crossref]  [PubMed]
  6. Logan PM, Primack SL, Staples C, Miller RR, Muller NL. Acute lung disease in the immunocompromised host. Diagnostic accuracy of the chest radiograph. Chest. 1995;108:1283-7. [Crossref]  [PubMed]
  7. Yazdani R, Abolhassani H, Asgardoon MH, Shaghaghi M, Modaresi M, Azizi G et al. Infectious and Noninfectious Pulmonary Complications in Patients With Primary Immunodeficiency Disorders. J Investig Allergol Clin Immunol. 2017;27:213-24. [Crossref]  [PubMed]
  8. Brett K, Dulong C, Severn M. Tuberculosis in People with Compromised Immunity: A Review of Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; March 11, 2020.
  9. Kobashi Y, Mouri K, Yagi S, Obase Y, Miyashita N, Okimoto N et al. Clinical features of immunocompromised and nonimmunocompromised patients with pulmonary tuberculosis. J Infect Chemother. 2007;13:405-10. [Crossref]  [PubMed]
  10. Mathur M, Badhan RK, Kumari S, Kaur N, Gupta S. Radiological Manifestations of Pulmonary Tuberculosis A Comparative Study between Immunocompromised and Immunocompetent Patients. J Clin Diagn Res. 2017;11:TC06-TC09. [Crossref]  [PubMed]  [PMC]
  11. Bustamante J. Mendelian susceptibility to mycobacterial disease: recent discoveries. Hum Genet. 2020;139:9931000. [Crossref]  [PubMed]  [PMC]
  12. Gathmann B, Mahlaoui N, Ceredih, Gerard L, Oksenhendler E, Warnatz K et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol. 2014;134:116-26. [Crossref]  [PubMed]
  13. Tarzi MD, Grigoriadou S, Carr SB, Kuitert LM, Longhurst HJ. Clinical immunology review series: An approach to the management of pulmonary disease in primary antibody deficiency. Clin Exp Immunol. 2009;155:147-55. [Crossref]  [PubMed]  [PMC]
  14. Wall LA, Wisner EL, Gipson KS, Sorensen RU. Bronchiectasis in Primary Antibody Deficiencies: A Multidisciplinary Approach. Front Immunol. 2020;11:522. [Crossref]  [PubMed]  [PMC]
  15. Bintalib HM, Davidsen JR, Van de Ven A, Goddard S, Burns SO, Warnatz K et al. Current Practices and Considerations in Lung Biopsy for Suspected Granulomatous-Lymphocytic Interstitial Lung Disease: A Clinician Survey. Respiration. 2024;103:692-700. [Crossref]  [PubMed]  [PMC]
  16. Cinetto F, Scarpa R, Carrabba M, Firinu D, Lougaris V, Buso H et al. Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) in Common Variable Immunodeficiency (CVID): A Multicenter Retrospective Study of Patients From Italian PID Referral Centers. Front Immunol. 2021;12:627423. [Crossref]  [PubMed]  [PMC]
  17. Hurst JR, Warnatz K, Collaboration ERSeCR. Interstitial lung disease in primary immunodeficiency: towards a brighter future. Eur Respir J. 2020;55. [Crossref]  [PubMed]
  18. Christou EAA, Giardino G, Stefanaki E, Ladomenou F. Asthma: An Undermined State of Immunodeficiency. Int Rev Immunol. 2019;38:70-78. [Crossref]  [PubMed]
  19. Lee SH, Ban GY, Kim SC, Chung CG, Lee HY, Lee JH et al. Association between primary immunodeficiency and asthma exacerbation in adult asthmatics. Korean J Intern Med. 2020;35:449-56. [Crossref]  [PubMed]  [PMC]
  20. Urm SH, Yun HD, Fenta YA, Yoo KH, Abraham RS, Hagan J et al. Asthma and risk of selective IgA deficiency or common variable immunodeficiency: a population-based case-control study. Mayo Clin Proc. 2013;88:813-21. [Crossref]  [PubMed]  [PMC]
  21. Cinetto F, Scarpa R, Pulvirenti F, Quinti I, Agostini C, Milito C. Appropriate lung management in patients with primary antibody deficiencies. Expert Rev Respir Med. 2019;13:823-38. [Crossref]  [PubMed]
  22. Maglione PJ. Chronic Lung Disease in Primary Antibody Deficiency: Diagnosis and Management. Immunol Allergy Clin North Am. 2020;40:437-59. [Crossref]  [PubMed]  [PMC]
  23. Cunningham-Rundles C. How I treat common variable immune deficiency. Blood. 2010;116:7-15. [Crossref]  [PubMed]  [PMC]
  24. Quinti I, Soresina A, Spadaro G, Martino S, Donnanno S, Agostini C et al. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency. J Clin Immunol. 2007;27:308-16. [Crossref]  [PubMed]
  25. Maarschalk-Ellerbroek LJ, de Jong PA, van Montfrans JM, Lammers JW, Bloem AC, Hoepelman AI et al. CT screening for pulmonary pathology in common variable immunodeficiency disorders and the correlation with clinical and immunological parameters. J Clin Immunol. 2014;34:642-54. [Crossref]  [PubMed]
  26. Zietkiewicz M, Buda N, Wiesik-Szewczyk E, Piskunowicz M, Grzegowska D, Jahnz-Rozyk K et al. Comparison of pulmonary lesions using lung ultrasound and high-resolution computed tomography in adult patients with primary humoral immunodeficiencies. Front Immunol. 2022;13:1031258. [Crossref]  [PubMed]  [PMC]
  27. Jolles S, Carne E, Brouns M, El-Shanawany T, Williams P, Marshall C et al. FDG PET-CT imaging of therapeutic response in granulomatous lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID). Clin Exp Immunol. 2017;187:138-45. [Crossref]  [PubMed]  [PMC]
  28. Tatci E, Biner IU, Tanyildiz HG, Ozmen O, Gokcek A, Sahin G et al. 18F-FDG PET/CT Imaging of Hodgkin Lymphoma in a Child with Common Variable Immunodeficiency. J Nucl Med Technol. 2016;44:259-60. [Crossref]  [PubMed]
  29. Capitanio S, Nordin AJ, Noraini AR, Rossetti C. PET/CT in nononcological lung diseases: current applications and future perspectives. Eur Respir Rev. 2016;25:247-58. [Crossref]  [PubMed]  [PMC]
  30. Arslan S, Poyraz N, Ucar R, Yesildag M, Yesildag A, Caliskaner AZ. Magnetic Resonance Imaging May Be a Valuable Radiation-Free Technique for Lung Pathologies in Patients with Primary Immunodeficiency. J Clin Immunol. 2016;36:66-72. [Crossref]  [PubMed]
  31. Eroglu-Ertugrul NG, Yalcin E, Oguz B, Ocal T, Kuskonmaz B, Emiralioglu N et al. The value of flexible bronchoscopy in pulmonary infections of immunosuppressed children. Clin Respir J. 2020;14:78-84. [Crossref]  [PubMed]  [PMC]
  32. Efrati O, Gonik U, Bielorai B, Modan-Moses D, Neumann Y, Szeinberg A et al. Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary disease in children with primary immunodeficiency and cancer. Pediatr Blood Cancer. 2007;48:324-9. [Crossref]  [PubMed]
  33. Feinsilver SH, Fein AM, Niederman MS, Schultz DE, Faegenburg DH. Utility of fiberoptic bronchoscopy in nonresolving pneumonia. Chest. 1990;98:1322-6. [Crossref]  [PubMed]
  34. van der Eerden MM, Vlaspolder F, de Graaff CS, Groot T, Jansen HM, Boersma WG. Value of intensive diagnostic microbiological investigation in lowand high-risk patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 2005;24:241-9. [Crossref]  [PubMed]
  35. Meduri GU, Beals DH, Maijub AG, Baselski V. Protected bronchoalveolar lavage. A new bronchoscopic technique to retrieve uncontaminated distal airway secretions. Am Rev Respir Dis. 1991;143:855-64. [Crossref]  [PubMed]
  36. Antoniou M, Grossman RF. Etiological diagnosis of pneumonia: A goal worth pursuing? Can J Infect Dis. 1995; 6:281-3. [Crossref]  [PubMed]  [PMC]
  37. Chogtu B, Mariya Elenjickal V, Shetty DU, Asbin M, Guddattu V, Magazine R. Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data Improves Outcomes in ICU Patients with Suspected Pneumonia. Crit Care Res Pract. 2023;2023:6928319. [Crossref]  [PubMed]  [PMC]
  38. Pociene I, Gauronskaite R, Galkauskas D, Mainelis A, Gruslys V, Danila E. Age as a Risk Factor in the Occurrence of Complications during or after Bronchoscopic Lung Biopsy. Geriatrics (Basel). 2022;7. [Crossref]  [PubMed]  [PMC]
  39. Joos L, Chhajed PN, Wallner J, Battegay M, Steiger J, Gratwohl A et al. Pulmonary infections diagnosed by BAL: a 12-year experience in 1066 immunocompromised patients. Respir Med. 2007;101:93-7. [Crossref]  [PubMed]
  40. Sakpal SV, Donahue S, Crespo HS, Auvenshine C, Agarwal SK, Nazir J et al. Utility of fiber-optic bronchoscopy in pulmonary infections among abdominal solid-organ transplant patients: A comprehensive review. Respir Med. 2019;146:81-86. [Crossref]  [PubMed]
  41. Shannon VR, Andersson BS, Lei X, Champlin RE, Kontoyiannis DP. Utility of early versus late fiberoptic bronchos copy in the evaluation of new pulmonary infiltrates following hematopoietic stem cell transplantation. Bone Marrow Transplant. 2010;45:647-55. [Crossref]  [PubMed]
  42. Rano A, Agusti C, Jimenez P, Angrill J, Benito N, Danes C et al. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures. Thorax. 2001;56:379-87. [Crossref]  [PubMed]  [PMC]
  43. Azoulay E, Mokart D, Rabbat A, Pene F, Kouatchet A, Bruneel F et al. Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data. Crit Care Med. 2008;36:100-7. [Crossref]  [PubMed]
  44. Li H, Gao H, Meng H, Wang Q, Li S, Chen H et al. Detection of Pulmonary Infectious Pathogens From Lung Biopsy Tissues by Metagenomic Next-Generation Sequencing. Front Cell Infect Microbiol. 2018;8:205. [Crossref]  [PubMed]  [PMC]
  45. Stahl DL, Richard KM, Papadimos TJ. Complications of bronchoscopy: A concise synopsis. Int J Crit Illn Inj Sci. 2015;5:189-95. [Crossref]  [PubMed]  [PMC]
  46. Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest. 1995;107:430-2. [Crossref]  [PubMed]
  47. Harris B, Lowy FD, Stover DE, Arcasoy SM. Diagnostic bronchoscopy in solid-organ and hematopoietic stem cell transplantation. Ann Am Thorac Soc. 2013;10:39-49. [Crossref]  [PubMed]
  48. Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC. Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest. 2004;125:712-22. [Crossref]  [PubMed]
  49. Wu GX, Khojabekyan M, Wang J, Tegtmeier BR, O'Donnell MR, Kim JY et al. Survival following lung resection in immunocompromised patients with pulmonary invasive fungal infection. Eur J Cardiothorac Surg. 2016;49:314-20. [Crossref]  [PubMed]  [PMC]
  50. Prasad R, Singh A, Balasubramanian V, Gupta N. Extensively drug-resistant tuberculosis in India: Current evidence on diagnosis & management. Indian J Med Res. 2017;145:271-93. [Crossref]  [PubMed]  [PMC]
  51. Farid S, Mohamed S, Devbhandari M, Kneale M, Richardson M, Soon SY et al. Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence--a National Centre's experience. J Cardiothorac Surg. 2013;8:180. [Crossref]  [PubMed]  [PMC]
  52. Polverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50. [Crossref]  [PubMed]
  53. Coutinho D, Fernandes P, Guerra M, Miranda J, Vouga L. Surgical treatment of bronchiectasis: A review of 20 years of experience. Rev Port Pneumol (2006). 2016;22:82-5. [Crossref]  [PubMed]
  54. Modi P, Uppe A. Lung Biopsy Techniques and Clinical Significance. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 28, 2022.
  55. Hiramatsu M, Shiraishi Y. Surgical management of non-cystic fibrosis bronchiectasis. J Thorac Dis. 2018;10:S3436-S45. [Crossref]  [PubMed]  [PMC]
  56. van de Ven A, Alfaro TM, Robinson A, Baumann U, Bergeron A, Burns SO et al. Managing Granulomatous-Lymphocytic Interstitial Lung Disease in Common Variable Immunodeficiency Disorders: e-GLILDnet International Clinicians Survey. Front Immunol. 2020;11:606333. [Crossref]  [PubMed]  [PMC]
  57. Takeda K, Kawashima M, Masuda K, Kimura Y, Yamamoto S, Enomoto Y et al. Long-Term Outcomes of Bronchial Artery Embolization for Patients with Non-Mycobacterial Non-Fungal Infection Bronchiectasis. Respiration. 2020;99:961-69. [Crossref]  [PubMed]
  58. Omachi N, Ishikawa H, Hara M, Nishihara T, Yamaguchi Y, Yamamoto Y et al. The impact of bronchial artery embolisation on the quality of life of patients with haemoptysis: a prospective observational study. Eur Radiol. 2021;31:5351-60. [Crossref]  [PubMed]  [PMC]
  59. Barnes S, Kotecha S, Douglass JA, Paul E, Hore-Lacy F, Stirling R et al. Evolving practice: X-linked agammaglobulinemia and lung transplantation. Am J Transplant. 2015;15:1110-3. [Crossref]  [PubMed]
  60. Nathan JA, Sharples LD, Exley AR, Sivasothy P, Wallwork J. The outcomes of lung transplantation in patients with bronchiectasis and antibody deficiency. J Heart Lung Transplant. 2005;24:1517-21. [Crossref]  [PubMed]
  61. Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn SJ, Floto AR et al. British Thoracic Society Guideline for bronchiectasis in adults. Thorax. 2019;74:1-69. [Crossref]