Pleurodesis practice in South and Central American countries.

www.chestpubs.org those receiving placebo. However, after adjusting for age, sex, smoking history, bronchoscopic biopsy, procedure time, operator experience, and baseline hemodynamic variables and oxygen saturation, the use of anticholinergic premedication was associated with signifi cantly lower airway secretions as reported by the bronchoscopist. Because excessive airway secretions are rarely encountered at bronchoscopy, 3 the antisecretory effects of atropinelike drugs might not have been appreciated in the earlier studies, given their limitations in sample size and failure to account for confounding factors. The absence of excessive airway secretions at bronchoscopy, even without antisecretory premedication, might also explain why such premedication may not be associated with clear clinical benefi t to the patient in terms of reduction in cough, patient discomfort, development of oxygen desaturation, or time taken for bronchoscopy. In summary, the comments by Dr Cowl that antisecretory drugs prior to bronchoscopy are not benefi cial and actually could be harmful in some patients and that the routine use of anticholinergic premedication during bronchoscopy should be abandoned are well supported by evidence, including that from the current study .