PDF herunterladen
Semin Respir Crit Care Med 2007; 28(5): 504-513
DOI: 10.1055/s-2007-991523
© Thieme Medical Publishers

Bronchoalveolar Lavage in Occupational Lung Diseases

Carlos Robalo Cordeiro1 , Jessica Cemlyn Jones1 , Tiago Alfaro1 , António Jorge Ferreira2
  • 1Department of Pulmonology and Allergology, Coimbra University Hospital, Coimbra, Portugal
  • 2Institute of Hygiene and Social Medicine, Coimbra Medical School, Coimbra, Portugal
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
02. November 2007 (online)

    Lizenzen und Reprints

ABSTRACT

Occupational lung diseases (OLDs) are related to the exposure and inhalation of organic, inorganic, and synthetic particles, fumes, gases, or infectious agents. From the long list of OLDs this article focuses the discussion on bronchoalveolar lavage (BAL) in parenchymal immunoinflammatory conditions, such as hypersensitivity pneumonitis (HP) and pneumoconiosis.

Several antigens may cause HP, including products of plant or animal origin, aerosolized microorganisms, and organic chemicals. BAL is used not only to assess the pathogenesis of these diseases but also to identify the typical pattern of intense lymphocytic alveolitis, usually with a CD4:CD8 ratio below normal and frequently with the presence of mast cells, plasma cells, and foamy macrophages.

Pneumoconioses are chronic interstitial lung diseases caused by the inhalation of mineral and metallic inorganic particles/dusts in an occupational setting, showing a decreasing prevalence in recent years.

BAL is a useful tool not only to express the complex pathogenic mechanisms of these entities but also in excluding other diagnoses and causes of alveolitis, and to document specific exposures, such as the identification of asbestos bodies (ABs) in asbestosis or the proliferative response of BAL lymphocytes to beryllium in chronic beryllium disease (CBD).

KEYWORDS

Bronchoalveolar lavage - occupational lung diseases - hypersensitivity pneumonitis - pneumoconiosis

REFERENCES

  • 1 Ross D J, Keynes H L, McDonald J C. SWORD'97: surveillance of work-related and occupational respiratory disease in UK.  Occup Med. 1998;  48 481-485
    CrossrefPubMedSuche in Google Scholar
  • 2 Heederik D. Epidemiology of occupational respiratory diseases and risk factors. In: Annesi-Maesano I, Gulsvik A, Viegi G Respiratory Epidemiology in Europe. European Respiratory Monograph 2000 5: 429-447
    Suche in Google Scholar
  • 3 National Institute for Occupational Safety and Health .Work-Related Lung Diseases Surveillance Report. December 2002
    Suche in Google Scholar
  • 4 U.S. Department of Labor .Workplace Injuries and Illnesses in 2002. December 2003
    Suche in Google Scholar
  • 5 Mapp C E. Introduction. In: Mapp CE Occupational Lung Disorders. European Respiratory Monograph 1999 4: 355
    Suche in Google Scholar
  • 6 Pozzi E. Extrinsic allergic alveolitis (hypersensitivity pneumonitis). In: Grassi C, Brambella C, Costabel U, Stockley RA, Naeije R, Rodriguez-Roisin R Pulmonary Diseases. London; McGraw-Hill International (UK) Ltd 1999: 289-294
    Suche in Google Scholar
  • 7 Campbell J M. Acute symptoms following work with hay.  BMJ. 1932;  2 1143-1151
    PubMedSuche in Google Scholar
  • 8 Mohr L C. Hypersensitivity pneumonitis.  Curr Opin Pulm Med. 2004;  10 401-411
    CrossrefPubMedSuche in Google Scholar
  • 9 Flandes J, Heili S, Seco J G, Sabillon O, Fernández I, Ortega A. Hypersensitivity pneumonitis caused by esparto dust in a young plaster worker: a case report and review of the literature.  Respiration. 2004;  71 421-423
    CrossrefPubMedSuche in Google Scholar
  • 10 Tsushima K, Fujimoto K, Yoshikawa S, Kawakami S, Koizumi T, Kubo K. Hypersensitivity pneumonitis due to Bunashimeji mushrooms in the mushroom industry.  Int Arch Allergy Immunol. 2005;  137 241-248
    CrossrefPubMedSuche in Google Scholar
  • 11 Patel A M, Ryu J H, Reed C E. Hypersensitivity pneumonitis: current concepts and future questions.  J Allergy Clin Immunol. 2001;  108 661-670
    CrossrefPubMedSuche in Google Scholar
  • 12 Fink J N, Schlueter D P, Sosman A J et al.. Clinical survey of pigeon breeders.  Chest. 1972;  62 277-281
    PubMedSuche in Google Scholar
  • 13 Wolff H, Teppo A M, Mutanen P et al.. Studies of cytokine levels in bronchoalveolar fluid lavage from patients with interstitial lung diseases.  Scand J Clin Lab Invest. 2003;  63 27-36
    PubMedSuche in Google Scholar
  • 14 Costabel U. Atlas of Bronchoalveolar Lavage. London; Chapman & Hall Medical 1998
    Suche in Google Scholar
  • 15 The BAL Cooperative Group Steering Committee . Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups.  Am Rev Respir Dis. 1990;  141 S169-S202
    PubMedSuche in Google Scholar
  • 16 Ando M, Konishi K, Yoneda R, Tamura M. Difference in the phenotypes of bronchoalveolar lavage lymphocytes in patients with summer-type hypersensitivity pneumonitis, farmer's lung, ventilation pneumonitis, and bird fancier's lung: report of a nationwide epidemiologic study in Japan.  J Allergy Clin Immunol. 1991;  87 1002-1009
    CrossrefPubMedSuche in Google Scholar
  • 17 Pardo A, Barrios R, Gaxiola M et al.. Increase of lung neutrophils in hypersensitivity pneumonitis is associated with lung fibrosis.  Am J Respir Crit Care Med. 2000;  161 1698-1704
    PubMedSuche in Google Scholar
  • 18 Turner-Warwick M, Haslam P L. The value of serial bronchoalveolar lavages in assessing the clinical progress of patients with cryptogenic fibrosing alveolitis.  Am Rev Respir Dis. 1987;  135 26-34
    PubMedSuche in Google Scholar
  • 19 Drent M, Jacobs J A, de Vries J et al.. Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis?.  Eur Respir J. 1999;  13 1338-1344
    CrossrefPubMedSuche in Google Scholar
  • 20 Perez-Padilla R, Salas J, Chapela R et al.. Mortality in Mexican patients with chronic pigeon breeder's lung compared with those with usual interstitial pneumonia.  Am Rev Respir Dis. 1993;  148 49-53
    PubMedSuche in Google Scholar
  • 21 Robalo Cordeiro C, Freitas S, Rodrigues B et al.. Diagnosis of respiratory bronchiolitis associated lung disease.  Monaldi Arch Chest Dis. 2006;  65 96-101
    PubMedSuche in Google Scholar
  • 22 Drent M, van Nierop M AMF, Gerritsen F A, Wouters E FM, Mulder P GH. A computer program using BALF-analysis results as a diagnostic tool in interstitial lung diseases.  Am J Respir Crit Care Med. 1996;  153 736-741
    CrossrefPubMedSuche in Google Scholar
  • 23 Drent M, Jacobs J A, Cobben N AM, Costabel U, Wouters E FM, Mulder P GH. Computer program supporting the diagnostic accuracy of cellular BALF analysis: a new release.  Respir Med. 2001;  95 781-786
    CrossrefPubMedSuche in Google Scholar
  • 24 Drent M, Du Bois R, Poletti V. Recent advances in the diagnosis and management of nonspecific interstitial pneumonia.  Curr Opin Pulm Med. 2003;  9 411-417
    CrossrefPubMedSuche in Google Scholar
  • 25 Cordeiro C R. Airway involvement in interstitial lung disease.  Curr Opin Pulm Med. 2006;  12 337-341
    PubMedSuche in Google Scholar
  • 26 Segorbe Luís A J, Abreu A F, Cordeiro C R et al.. Subclinical alveolitis in pigeon breeders.  Sarcoidosis. 1989;  6(Suppl1) 61
    PubMedSuche in Google Scholar
  • 27 Freitas M S, Pêgo A, Cordeiro C R et al.. Subclinical alveolitis in amiodarone treated patients.  Eur Resp Rev. 1992;  2 224
    PubMedSuche in Google Scholar
  • 28 Baganha M F, Abreu F, Teixeira M L et al.. Subclinical alveolitis in asbestos exposed workers.  Eur Respir Rev. 1991;  1 7
    PubMedSuche in Google Scholar
  • 29 Robalo Cordeiro A JA, Leite A CP, Lima M A et al.. Early lung involvement in silica exposed workers.  Eur Respir J. 1992;  5(Suppl 15) 521
    PubMedSuche in Google Scholar
  • 30 Cordeiro C R, Mesquita L, Teixeira L, Cardoso Oliveira L. Subclinical alveolitis in extrathoracic granulomatous disease.  Sarcoidosis. 2001;  18 34-35
    PubMedSuche in Google Scholar
  • 31 Baganha M F, Marques M AT, Leite I et al.. Subclinical alveolitis in asymptomatic individuals infected by HIV.  Eur Respir J. 1994;  7(Suppl 18) 121
    CrossrefPubMedSuche in Google Scholar
  • 32 Laviolette M, Cormier Y, Loiseau A, Soler P, Leblanc P, Hance A J. Bronchoalveolar mast cells in normal farmers and subjects with farmer's lung.  Am Rev Respir Dis. 1991;  144 855-860
    PubMedSuche in Google Scholar
  • 33 Robalo Cordeiro A JA. Alveolites subclínicas: perspectiva imunológica.  Rev Port Imunoalerg. 1992;  3 73-85
    PubMedSuche in Google Scholar
  • 34 Ávila R, Lacey J. The role of Penicillium frequentans in suberosis: respiratory disease in cork workers.  Clin Allergy. 1974;  4 109
    PubMedSuche in Google Scholar
  • 35 Morais A, Winck J C, Delgado L et al.. Suberose e doença dos criadores de aves: estudo comparativo do perfil radiológico funcional e do lavado broncoalveolar.  Rev Port Pneumol. 2004;  10 63-75
    PubMedSuche in Google Scholar
  • 36 Chan-Yeung M, Dimichi-Ward H. Natural history of occupational lung disease. In: Mapp CE Occupational Lung Disorders. European Respiratory Monograph 1999 4: 446-463
    Suche in Google Scholar
  • 37 Kayacan O, Beder S, Karnak D. Cellular profile of bronchoalveolar lavage fluid in Turkish miners.  Postgrad Med J. 2003;  79 527-530
    CrossrefPubMedSuche in Google Scholar
  • 38 Rottoli P, Bargagli E, Perari M G, Cintorino M, Romeo R. Gardening in greenhouses as a risk factor for silicosis.  Respiration. 2003;  70 221-223
    CrossrefPubMedSuche in Google Scholar
  • 39 Antonini J M, Taylor M D, Zimmer A T, Roberts J R. Pulmonary responses to welding fumes: role of metal constituents.  J Toxicol Environ Health, Part A. 2003;  67 233-249
    CrossrefPubMedSuche in Google Scholar
  • 40 Robalo Cordeiro A JA, Baganha M F, Carmo J GA, Gaspar E, Lima M AM, Rosa M AS. Le lavage broncho-alvéolaire chez des mineurs d'uranium.  Rev Fr Mal Respir. 1981;  9 241-256
    PubMedSuche in Google Scholar
  • 41 Barbarin V, Xing Z, Delos M, Lison D, Huaux F. Pulmonary overexpression of IL-10 augments lung fibrosis and TH2 responses induced by silica particles.  Am J Physiol Lung Cell Mol Physiol. 2005;  288 L841-L848
    PubMedSuche in Google Scholar
  • 42 Robalo Cordeiro A JA, Cordeiro C R. Exposição pulmonar profissional: pneumoconioses. In: Marques Gomes MJ, Sotto-Mayor R Tratado de Pneumologia. Portugal: Permanyer 2003 2: 1407-1419
    Suche in Google Scholar
  • 43 Bégin R. Asbestos-related diseases. In: Mapp CE Occupational Lung Disorders. European Respiratory Monograph 1999 4: 158-177
    Suche in Google Scholar
  • 44 Teschler H, Konietzo N, Schoenfeld B, Ramin C, Schraps T, Costabel U. Distribution of asbestos bodies in the human lung as determined by bronchoalveolar lavage.  Am Rev Respir Dis. 1993;  147 1211-1215
    PubMedSuche in Google Scholar
  • 45 Vathesatogkit P, Harkin T J, Addrizo-Harris D J, Bodkin M, Crane M, Rom W N. Clinical correlation of asbestos bodies in BAL fluid.  Chest. 2004;  126 966-971
    CrossrefPubMedSuche in Google Scholar
  • 46 De Vuyst P, Dumortier P, Moulin E et al.. Guidelines for mineral fibre analysis in biological samples: report of the ERS Working Group. European Respiratory Society.  Eur Respir J. 1998;  11 1416-1426
    CrossrefPubMedSuche in Google Scholar
  • 47 Romeo R, Scancarello G, Cassano P, Cioni F, Bacaloni A, Sartorelli P. Assessment of asbestos exposure via mineralogical analysis of bronchoalveolar lavage fluid.  Med Lav. 2004;  95 17-31
    PubMedSuche in Google Scholar
  • 48 De Vuyst P, Dumortier P, Moulin E et al.. Asbestos bodies in bronchoalveolar lavage reflect lung asbestos body concentration.  Eur Respir J. 1988;  1 362-367
    PubMedSuche in Google Scholar
  • 49 Sebastien P, Armstrong B, Monchaux G et al.. Asbestos bodies in bronchoalveolar lavage fluid and in lung parenchyma.  Am Rev Respir Dis. 1988;  137 75-78
    PubMedSuche in Google Scholar
  • 50 De Vuyst P, Dumortier P, Moulin E et al.. Diagnostic value of asbestos bodies in bronchoalveolar lavage fluid.  Am Rev Respir Dis. 1987;  136 1219-1224
    PubMedSuche in Google Scholar
  • 51 Roggli V L, Coin P G, MacIntyre N R, Bell D Y. Asbestos content of bronchoalveolar lavage fluid: a comparison of light and scanning electron microscopic analysis.  Acta Cytol. 1994;  38 502-510
    PubMedSuche in Google Scholar
  • 52 Dumortier P, Thimpont J, de Maertelaer V, De Vuyst P. Trends in asbestos body count in bronchoalveolar lavage fluid over two decades.  Eur Respir J. 2003;  22 519-524
    CrossrefPubMedSuche in Google Scholar
  • 53 Rom W N, Weiden M, Garcia R et al.. Acute eosinophilia in a New York City firefighter exposed to World Trade Center dust.  Am J Respir Crit Care Med. 2002;  166 797-800
    CrossrefPubMedSuche in Google Scholar
  • 54 Fireman E, Greif J, Schwarz Y et al.. Assessment of hazardous dust exposure by BAL and Induced Sputum.  Chest. 1999;  115 1720-1728
    CrossrefPubMedSuche in Google Scholar
  • 55 Teschler H, Thompson A B, Dollenkamp R, Konietzo N, Costabel U. Relevance of asbestos bodies in sputum.  Eur Respir J. 1996;  9 680-686
    CrossrefPubMedSuche in Google Scholar
  • 56 Fireman E, Lerman Y. Induced sputum in interstitial lung diseases.  Curr Opin Pulm Med. 2006;  12 318-322
    PubMedSuche in Google Scholar
  • 57 Sulotto F, Capellaro E, Chiesa A et al.. Relationship between asbestos bodies in sputum and the number of specimens.  Scand J Work Environ Health. 1997;  23 48-53
    PubMedSuche in Google Scholar
  • 58 Capellaro E, Chiesa A, Villari S et al.. Asbestos bodies in bronchoalveolar lavage fluid and sputum.  Med Lav. 1997;  88 99-107
    PubMedSuche in Google Scholar
  • 59 Fireman E, Greif J, Schwarz Y et al.. Assessment of hazardous dust exposure by BAL and induced sputum.  Chest. 1999;  115 1720-1728
    CrossrefPubMedSuche in Google Scholar
  • 60 Newman L S, Mroz M M, Balkisson R, Maier L A. Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk.  Am J Respir Crit Care Med. 2005;  171 54-60
    CrossrefPubMedSuche in Google Scholar
  • 61 Sawyer R T, Parsons C E, Fontenot A P et al.. Beryllium-induced tumor necrosis factor- α production by CD4 + T cells is mediated by HLA-DP.  Am J Respir Cell Mol Biol. 2004;  31 122-130
    CrossrefPubMedSuche in Google Scholar
  • 62 Rossman M D, Kern J A, Elias J A et al.. Proliferative response of bronchoalveolar lymphocytes to beryllium.  Ann Intern Med. 1988;  108 687-693
    CrossrefPubMedSuche in Google Scholar
  • 63 Zhang H, Li Q, Yao R, Guo N. Experimental studies on the therapeutic effects of lung lavage with large volume of saline on silicosis.  Wei Sheng Yan Jiu. 1997;  26 77-79
    PubMedSuche in Google Scholar

Carlos Robalo CordeiroM.D. Ph.D. 

Department of Pulmonology and Allergology, Coimbra University Hospital

Praceta Mota Pinto, 3000 Coimbra, Portugal

eMail: crobalo@mail.telepac.pt