Bronchoscopic phenotypes of airway injury across burn severity: Mechanisms, classification, and clinical implications
4 affiliations
- 1Department of Internal Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran
- 2Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- 3Department of Emergency Medicine, Poursina Clinical Development Unit, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- 4Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Abstract
Burn-associated inhalation injury remains a major determinant of morbidity and mortality after thermal trauma, and bronchoscopy plays a central role in the direct assessment of airway injury. However, substantial heterogeneity persists in the interpretation of bronchoscopic findings across different injury severities. This structured narrative review examines bronchoscopic phenotypes in burn-related airway injury, with emphasis on underlying pathophysiologic mechanisms, current classification systems, severity stratification, temporal evolution, age-related modifiers, prognostic evidence, and clinical implications. English-language literature published from 2000 through 2025 was identified through topic-focused searches in Semantic Scholar and backward and forward reference-chain searching. Sources addressing bronchoscopic findings, grading systems, age-related variation, temporal changes, multimodal correlation, prognosis, and management were considered, and the evidence was synthesized qualitatively. The review was not designed as a systematic review or meta-analysis. Bronchoscopic findings encompass a continuum ranging from soot deposition, mild erythema, and limited edema to ulceration, mucosal sloughing, necrotic debris, cast formation, and airway obstruction, reflecting the interplay of thermal, chemical, inflammatory, and mechanical processes. Although existing grading systems facilitate communication and clinical and research stratification, their inter-rater reliability and ability to predict outcomes are variable. Interpretation of bronchoscopic phenotypes should therefore consider the timing of bronchoscopy, patient age, burn burden, pulmonary physiology, imaging findings, and the broader clinical trajectory. A phenotype-based framework may improve description, risk stratification, and multidisciplinary communication; however, bronchoscopic appearance should not be used as an isolated prognostic or treatment rule. Future priorities include standardized image acquisition and terminology, external validation of grading systems, age-sensitive assessment, and prospective evaluation of imaging-assisted and computational approaches.
Related
- Sepsis-associated endothelial dysfunction: clinical phenotypes, biomarkers, bedside evidence, and translational implications
- Sex-specific health phenotypes in a large qatari cohort: a cross-sectional analysis with implications for population health policy
- Multimodal fusion of SpO₂ time series and clinical data for explainable classification of obstructive sleep apnea severity
- Modeling Factors Associated with Smoking Dependence Severity Using Binary Classification-Based Machine Learning: Prediction with Hematological and Demographic Patient Data
- Quantitative CT features for COPD classification and GOLD spirometric severity assessment: a single-center model-development study
BibTeX
@article{soleimani2026bronchoscopic,
title = {{Bronchoscopic phenotypes of airway injury across burn severity: Mechanisms, classification, and clinical implications}},
author = {Amir Morteza Soleimani and Milad Nasrollahzadeh and Farnaz Mohseni and Mohsen Sadeghi},
journal = {Iranian Journal of Burns and Wound Research},
year = {2026},
month = oct,
doi = {10.66224/ijbwr.2.3.64},
url = {https://doi.org/10.66224/ijbwr.2.3.64},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Bronchoscopic phenotypes of airway injury across burn severity: Mechanisms, classification, and clinical implications
AU - Amir Morteza Soleimani
AU - Milad Nasrollahzadeh
AU - Farnaz Mohseni
AU - Mohsen Sadeghi
PY - 2026
DA - 2026/10/26
JO - Iranian Journal of Burns and Wound Research
DO - 10.66224/ijbwr.2.3.64
UR - https://doi.org/10.66224/ijbwr.2.3.64
AB - Burn-associated inhalation injury remains a major determinant of morbidity and mortality after thermal trauma, and bronchoscopy plays a central role in the direct assessment of airway injury. However, substantial heterogeneity persists in the interpretation of bronchoscopic findings across different injury severities. This structured narrative review examines bronchoscopic phenotypes in burn-related airway injury, with emphasis on underlying pathophysiologic mechanisms, current classification systems, severity stratification, temporal evolution, age-related modifiers, prognostic evidence, and clinical implications. English-language literature published from 2000 through 2025 was identified through topic-focused searches in Semantic Scholar and backward and forward reference-chain searching. Sources addressing bronchoscopic findings, grading systems, age-related variation, temporal changes, multimodal correlation, prognosis, and management were considered, and the evidence was synthesized qualitatively. The review was not designed as a systematic review or meta-analysis. Bronchoscopic findings encompass a continuum ranging from soot deposition, mild erythema, and limited edema to ulceration, mucosal sloughing, necrotic debris, cast formation, and airway obstruction, reflecting the interplay of thermal, chemical, inflammatory, and mechanical processes. Although existing grading systems facilitate communication and clinical and research stratification, their inter-rater reliability and ability to predict outcomes are variable. Interpretation of bronchoscopic phenotypes should therefore consider the timing of bronchoscopy, patient age, burn burden, pulmonary physiology, imaging findings, and the broader clinical trajectory. A phenotype-based framework may improve description, risk stratification, and multidisciplinary communication; however, bronchoscopic appearance should not be used as an isolated prognostic or treatment rule. Future priorities include standardized image acquisition and terminology, external validation of grading systems, age-sensitive assessment, and prospective evaluation of imaging-assisted and computational approaches.
SN - 3060-8414
ER -