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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
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Publikationsverlauf

Publikationsdatum:
02. November 2007 (online)

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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.

KEYWORDS

Idiopathic interstitial pneumonia (IIP) - cryptogenic organizing pneumonia (COP) - idiopathic pulmonary fibrosis (IPF) - nonspecific interstitial pneumonia (NSIP) - BAL lymphocytosis, CD4:CD8 ratio

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Sonoko NagaiPh.D. M.D. 

Sangyou Clinic

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

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