Abstract
Background: Cytologic examination of bronchoalveolar lavage (BAL) provides a microscopic feature on the inflammatory status of small airway disease (SAD) as well as interstitial pneumonia. The purpose of this study is to investigate the usefulness of BAL evaluation in SAD.
Methods: Twenty-three subjects (male/female = 6/17, age 40-81 years) with suspected SAD who underwent lung function testing and chest computed tomography (CT) were enrolled. They had slightly obstructive impairment in pulmonary function testing and obstruction of the bronchioles detected indirectly by CT as a mosaic attenuation pattern of the lung parenchyma. We performed BAL with instillation of saline (50 mL, three times) into the airways and examined cellular composition in BAL fluid microscopically. In each case, the result of BAL was evaluated, based on clinical diagnosis and therapeutic effect of SAD.
Results: Eighteen patients had increased number in BAL cells. Four patients had an increase in eosinophils (10-73%), eleven patients in lymphocytes (28-90%) and three patients in neutrophils (67-90%). Five patients, however, showed normal range in both BAL cells and leucocyte differentiation. BAL cell differentiation in the first, second and third sample enabled us to differentiate between the location of bronchial and bronchiolar disease.
Conclusion: The cases with similar history, radiographic findings and lung function often showed different cellular composition in BAL. We conclude that a likely diagnosis of SAD might be reached, when BAL is combined with clinical history, CT, laboratory data and lung function. BAL evaluation might have a strong impact on treatment decisions.
- © 2014 ERS
