Semin Respir Crit Care Med 2007; 28(5): 496-503
DOI: 10.1055/s-2007-991522
© Thieme Medical Publishers

Bronchoalveolar Lavage in Idiopathic Interstitial Lung Diseases

Sonoko Nagai1 , Tomohiro Handa2 , Yutaka Ito2 , Minoru Takeuchi3 , Takateru Izumi1
  • 1Central Clinic/Research Center, Kyoto, Japan
  • 2Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 3Department of Bioengineering, Sangyou University, Kyoto, Japan
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
02. November 2007 (online)

ABSTRACT

Bronchoalveolar lavage (BAL) is useful for diagnosing various interstitial lung diseases (ILDs) and monitoring ILD during treatment. The ability to detect specific agents or substances by using BAL is especially helpful in determining whether idiopathic ILD has a background causality. BAL in combination with other intensive examinations may enable the definitive diagnosis of an idiopathic ILD.

Among the idiopathic ILDs of concern, this article focuses on idiopathic interstitial pneumonia (IIP) and cryptogenic organizing pneumonia (COP). IIP and COP are classified together as idiopathic interstitial pneumonia (IIP), an integrated clinicoradiographic pathological disease entity. BAL has identified two points important for differentiating the disease entity: a paucity of lymphocytes appears in the BAL fluid of patients with idiopathic pulmonary fibrosis (IPF), and lymphocytosis with a decreased CD4:CD8 ratio appears in patients with COP. These findings can be useful, in combination with high-resolution computed tomographic (HRCT) data, for selecting a favorable treatment option. On the other hand, these rules cannot be applied to IP associated with collagen vascular disease (CVD). Furthermore, some IIP patients may manifest features of CVD during the clinical course after the detection of IP (interstitial pneumonia). Thus the definite role of BAL cell profiles remains to be determined.

REFERENCES

  • 1 Meyer K C. The role of bronchoalveolar lavage in interstitial lung disease.  Clin Chest Med. 2004;  25 637-649
  • 2 American Thoracic Society . American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias.  Am J Respir Crit Care Med. 2002;  165 277-304
  • 3 Nagai S, Kitaichi M, Izumi T. Classification and recent advances in idiopathic interstitial pneumonia.  Curr Opin Pulm Med. 1998;  4 256-260
  • 4 Nagai S, Handa T, Tabuena R, Kitaichi M, Izumi T. Nonspecific interstitial pneumonia: a real clinical entity?.  Clin Chest Med. 2004;  25 705-715
  • 5 Nagai S, Hoshino Y, Hayashi M, Ito I. Smoking-related interstitial lung diseases.  Curr Opin Pulm Med. 2000;  6 415-419
  • 6 Travis W D, Matsui K, Moss J, Ferrans V J. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia.  Am J Surg Pathol. 2000;  24 19-33
  • 7 Nagai S, Kitaichi M, Itoh H, Nishimura K, Izumi T, Colby T V. Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP.  Eur Respir J. 1998;  12 1010-1019
  • 8 Bjoraker J A, Ryu J H, Edwin M K et al.. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med. 1998;  157 199-203
  • 9 Latsi P I, du Bois R M, Nicholson A G et al.. Fibrotic idiopathic interstitial pneumonia: the prognostic value of longitudinal functional trends.  Am J Respir Crit Care Med. 2003;  168 531-537
  • 10 Vathesatogkit P, Harkin T J, Addrizzo-Harris D J, Bodkin M, Crane M, Rom W N. Clinical correlation of asbestos bodies in BAL fluid.  Chest. 2004;  126 966-971
  • 11 Vidal S, de la Horra C, Martin J et al.. Pneumocystis jiroveci colonisation in patients with interstitial lung disease.  Clin Microbiol Infect. 2006;  12 231-235
  • 12 Sattler F, Nichols L, Hirano L et al.. Nonspecific interstitial pneumonitis mimicking Pneumocystis carinii pneumonia.  Am J Respir Crit Care Med. 1997;  156 912-917
  • 13 Rano A, Agusti C, Jimenez P et al.. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures.  Thorax. 2001;  56 379-387
  • 14 Hirakata M, Suwa A, Nagai S et al.. Anti-KS: identification of autoantibodies to asparaginyl-transfer RNA synthetase associated with interstitial lung disease.  J Immunol. 1999;  162 2315-2320
  • 15 Ohtani Y, Saiki S, Kitaichi M et al.. Chronic bird fancier's lung: histopathological and clinical correlation: an application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias.  Thorax. 2005;  60 665-671
  • 16 Katzenstein A LA, Fiorelli R F. Nonspecific Interstitial pneumonia/fibrosis: histologic features and clinical significance.  Am J Surg Pathol. 1994;  18 136-147
  • 17 Suh G Y, Kang E H, Chung M P et al.. Early intervention can improve clinical outcome of acute interstitial pneumonia.  Chest. 2006;  129 753-761
  • 18 Cordier J F. Cryptogenic organising pneumonia.  Eur Respir J. 2006;  28 422-446
  • 19 Shimizu S, Yoshinouchi T, Ohtsuki Y et al.. The appearance of S-100 protein-positive dendritic cells and the distribution of lymphocytes subsets in idiopathic nonspecific interstitial pneumonia.  Respir Med. 2002;  96 770-776
  • 20 Ju Ryu Y, Pyo Chung M, Han J et al.. Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias.  Respir Med. 2007;  101 655-660
  • 21 King Jr T E, Schwarz M I, Brown K et al.. Idiopathic pulmonary fibrosis: relationship between histopathologic features and mortality.  Am J Respir Crit Care Med. 2001;  164 1025-1032
  • 22 Flaherty K R, Colby T V, Travis W D et al.. Fibroblastic foci in usual interstitial pneumonia.  Am J Respir Crit Care Med. 2003;  167 1410-1415
  • 23 Nicholson A G, Colby T V, DuBois R M et al.. Prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis.  Am J Respir Crit Care Med. 2000;  162 2213-2217
  • 24 Nagao T, Nagai S, Kitaichi M et al.. Usual interstitial pneumonia: idiopathic pulmonary fibrosis versus collagen vascular diseases.  Respiration. 2001;  68 151-159
  • 25 Veeraraghavan S, Latsi P I, Wells A U et al.. BAL findings in idiopathic nonspecific interstitial pneumonia and usual interstitial pneumonia.  Eur Respir J. 2003;  22 239-244
  • 26 Flaherty K R, Travis W D, Colby T V et al.. Histopathologic variability in usual and nonspecific interstitial pneumonias.  Am J Respir Crit Care Med. 2001;  164 1722-1727
  • 27 Papiris S A, Kollintza A, Kitsanta P et al.. Relationship of BAL and lung tissue CD4 + and CD8 + T lymphocytes, and their ratio in idiopathic pulmonary fibrosis.  Chest. 2005;  128 2971-2977
  • 28 Tabuena R P, Nagai S, Tsutsumi T et al.. Cell profiles of bronchoalveolar lavage fluid as prognosticators of idiopathic pulmonary fibrosis/usual interstitial pneumonia among Japanese patients.  Respiration. 2005;  72 490-498
  • 29 Parambil J G, Myers J L, Ryu J H. Histopathologic features and outcome of patients with acute exacerbation of idiopathic pulmonary fibrosis undergoing surgical lung biopsy.  Chest. 2005;  128 3310-3315
  • 30 Handa T, Nagai S, Miki S et al.. Incidence of pulmonary hypertension and its clinical relevance in patients with interstitial pneumonias: comparison between idiopathic and collagen vascular disease associated interstitial pneumonias.  Int Med. 2007;  46 831-837
  • 31 Falfan-Valencia R, Camarena A, Juarez A et al.. Major histocompatibility complex and alveolar epithelial apoptosis in idiopathic pulmonary fibrosis.  Hum Genet. 2005;  118 235-244
  • 32 Selman M, Pardo A, Barrera L et al.. Gene expression profiles distinguish idiopathic pulmonary fibrosis from hypersensitivity pneumonitis.  Am J Respir Crit Care Med. 2006;  173 188-198
  • 33 Ishii H, Mukae H, Kadota J et al.. Increased levels of interleukin-18 in bronchoalveolar lavage fluid of patients with idiopathic nonspecific interstitial pneumonia.  Respiration. 2005;  72 39-45
  • 34 Yoshioka S, Mukae H, Sugiyama K et al.. High-BAL fluid concentrations of RANTES in nonspecific interstitial pneumonia compared with usual interstitial pneumonia.  Respir Med. 2004;  98 945-951
  • 35 Park C S, Chung S W, Ki S Y et al.. Increased levels of interleukin-6 are associated with lymphocytosis in bronchoalveolar lavage fluids of idiopathic nonspecific interstitial pneumonia.  Am J Respir Crit Care Med. 2000;  162(3, Pt 1) 1162-1168
  • 36 Rottoli P, Magi B, Cianti R et al.. Carbonylated proteins in bronchoalveolar lavage of patients with sarcoidosis, pulmonary fibrosis associated with systemic sclerosis and idiopathic pulmonary fibrosis.  Proteomics. 2005;  5 2612-2618
  • 37 Rottoli P, Magi B, Perari M G et al.. Cytokine profile and proteome analysis in bronchoalveolar lavage of patients with sarcoidosis, pulmonary fibrosis associated with systemic sclerosis and idiopathic pulmonary fibrosis.  Proteomics. 2005;  5 1423-1430

Sonoko NagaiPh.D. M.D. 

Sangyou Clinic

56-58, Sangyou Takakura, Nakagyouku, Kyoto 604-8111, Japan

eMail: nagai@kuhp.kyoto-u.ac.up