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1 Interstitial Lung Disease Unit, Dept of Occupational and Environmental Medicine, 2 Dept of Pathology, and 4 Cell Biology Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College of Science Technology and Medicine, London, UK. 3 Dept of Pathology, Mayo Clinic, Scottsdale, AZ, USA
CORRESPONDENCE: R.M du Bois, Interstitial Lung Disease Unit, National Heart and Lung Institute, Royal Brompton Hospital, 1B Manresa Road, London SW3 6LR, UK. Fax: 44 2073518336. E-mail: r.dubois@rbh.nthames.nhs.uk
Keywords: bronchoalveolar lavage, interstitial lung disease, pulmonary fibrosis
Received: November 18, 2002
Accepted March 12, 2003
Idiopathic pulmonary fibrosis (IPF), which has the histological pattern of usual interstitial pneumonia (UIP), is a progressive interstitial lung disease with a poor prognosis. Idiopathic interstitial pneumonias with a histological pattern of nonspecific interstitial pneumonia (NSIP) have a better prognosis than UIP, and may present with a clinical picture identical to IPF. The authors hypothesised that bronchoalveolar lavage (BAL) findings may distinguish between UIP and NSIP, and have prognostic value within disease subgroups.
BAL findings were studied retrospectively in 54 patients with histologically proven (surgical biopsy) idiopathic UIP (n=35) or fibrotic NSIP (n=19), all presenting clinically as IPF. These findings were also compared with the BAL profile of patients with other categories of idiopathic interstitial pneumonias.
BAL total and differential cell counts did not differ between the two groups. Survival was better in NSIP. In neither group were BAL findings predictive of survival or changes in lung function at 1 yr, even after adjustment for disease severity, smoking andtreatment. BAL differential counts in fibrotic NSIP differed from respiratory bronchiolitis-associated interstitial lung disease, but not from desquamative interstitial pneumonia or cellular NSIP.
The authors conclude that bronchoalveolar lavage findings do not discriminate between usual interstitial pneumonia and nonspecific interstitial pneumonia in patients presenting with clinical features of idiopathic pulmonary fibrosis, and have no prognostic value, once the distinction between the two has been made histologically.
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