Background: This review is a continuation of preceding papers on invasive methods applied
for diagnostics or drug delivery with questionable clinical indications and/or research purposes. It aims
to serve as a reminder that the risk-to-benefit ratio should be kept as low as possible.
Methods: Review of literature and Russian patents; author’s observations since 1983.
Results: The use of bronchoscopy as a diagnostic and drug delivery method in asthma, bronchitis and
tuberculosis is discussed in some detail. Bronchoscopy was applied in children and adults with asthma
both during remissions and exacerbations, as well as pre-asthma defined as bronchitis with elements of
bronchospasm and allergy. In the pediatric clinic of the Moscow medical academy, endoscopic methods
have been applied in children and newborns for diagnostic, therapeutic and research purposes since the
1960s. Various bronchoscopic methods have been patented; several patents are presented here as examples.
The concept of informed consent and assent applied to children and adolescents is also discussed.
Conclusion: Significance of the procedural quality assurance in endoscopy is stressed, particularly,
training methods not involving patients. It is also important to monitor endoscopic skills and objectively
select capable trainees.