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Eur Respir J 2001; 17:281-286
Copyright ©ERS Journals Ltd 2001

Interlobar differences in bronchoalveolar lavage fluid from children with cystic fibrosis

J.P. Gutierrez1, K. Grimwood3, D.S. Armstrong1, J.B. Carlin2, R. Carzino3, A. Olinsky1, C.F. Robertson1 and P.D. Phelan2,3

1 Dept of Respiratory Medicine and the 2 Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, and 3 Dept of Paediatrics, University of Melbourne, Parkville, Victoria, 3052, Australia

CORRESPONDENCE: K. Grimwood, Dept of Paediatrics, Wellington School of Medicine, PO Box 7343, Wellington, 6015, New Zealand. Fax: 64 43855898

Keywords: bacteria, bronchoalveolar lavage, child, cystic fibrosis, inflammation

Received: May 12, 2000
Accepted October 18, 2000

This study was supported by grants from the Murdoch Children's Research Institute and the JB Were Charitable Fund, Melbourne, Australia.

Bronchoalveolar lavage (BAL) performed in specialist centres has improved the understanding of infant cystic fibrosis (CF) lung disease. As most researchers sample from a single lobe, it was determined whether BAL results could be generalized to other lung segments.

Thirty-three CF children, aged 1.5–57 months, underwent in random order sequential BAL of their right middle and lingula lobes. Specimens from each lobe had separate quantitative bacteriology, cytology and cytokine analysis.

Bacterial counts ≥1x105 colony forming units (cfu)·mL–1 were observed in nine (27%) subjects, including six involving only the right middle lobe. These six children had similar inflammatory indices in their right middle and lingula lobes, and interleukin (IL)-8 concentrations in the latter were significantly higher than that observed within the lingula lobes of the 24 CF children with bacterial counts <1x105 cfu·mL–1. Lingula neutrophil and IL-8 levels correlated best with right middle lobe bacteria numbers.

This observational study in cystic fibrosis children suggests that while inflammation is detected in both lungs, bacterial distribution may be more inhomogeneous. Bronchoalveolar lavage microbiological findings from a single lobe may therefore, not be generalized to other lung segments. When performing bronchoalveolar lavage in cystic fibrosis children, it is important to sample from multiple sites.




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