Comparative Analysis of Bronchoalveolar Lavages in Interstitial Lung Diseases

Kyu Sub Song; Woon Bo Heo; Dong Il Won

doi:10.3343/kjlm.2007.27.3.221

Journal List > Korean J Lab Med > v.27(3) > 1011398

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Song, Heo, and Won: Comparative Analysis of Bronchoalveolar Lavages in Interstitial Lung Diseases

Original Article

Korean J Leg Med 2007;27(3):221-227.

Published online: 10 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.3.221

Comparative Analysis of Bronchoalveolar Lavages in Interstitial Lung Diseases

Kyu Sub Song, M.D., Woon Bo Heo, M.D., Dong Il Won, M.D.

Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Korea

Received 2 January 2007 Revised 14 March 2007 Accepted 14 March 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

This study was purposed to find out the differences in the lymphocyte subsets and differential cell counts of the bronchoalveolar lavage (BAL) fluid in patients with interstitial lung disease (ILD) and to analyze the differences according to their ages, gender and smoking habits.

Methods

BAL fluid samples of 141 ILD patients were examined for lymphocyte subsets and differential cell counts, and the differences among the patients were analyzed according to their diseases. Then, within the three most common disease groups, the differences were further analyzed by the age, gender and smoking habit of the patients.

Results

There were no statistically significant differences in total cell counts (per millimeters of BAL fluid) among the patient groups with each ILD. However, significant differences were observed in the percentages of neutrophils, lymphocytes, eosinophils, and macrophages of BAL fluid. Also, in lymphocyte subset analyses, the percentages of total T cells, B cells, CD4+ T cells, CD8+ T cells, CD4/CD8 T cell ratios, and NK cells were significantly different among the patients with each ILD. However, within the same disease group, there were no differences in differential cell counts and lymphocyte subset analyses according to the age, smoking habit, and gender of the patients.

Conclusions

Although the age, smoking habit and gender did not have an effect on the BAL fluid analyses among the patients with the same ILD, there were significant differences among the patients with each ILD; therefore, the differential cell counts and lymphocyte subset analyses of BAL fluid can be useful in differential diagnosis for determining the types of ILD.

Keywords: Bronchoalveolar lavage, Differential cell count, Lymphocyte subset

References

1. Ikeda S. Flexible bronchofiberscope. Ann Otol Rhinol Laryngol. 1970; 79:916–23.

2. Mandel MA, Dvorak KJ, Worman LW, DeCosse JJ. Immunoglobulin content in the bronchial washings of patients with benign and malignant pulmonary disease. N Engl J Med. 1976; 295:694–8.

3. Ognibene FP, Shelhamer J, Gill V, Macher AM, Loew D, Parker MM, et al. The diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome using subsegmental bronchoalveolar lavage. Am Rev Respir Dis. 1984; 129:929–32.

4. Lang DM, Simon RA, Mathison DA, Timms RM, Stevenson DD. Safety and possible efficacy of fiberoptic bronchoscopy with lavage in the management of refractory asthma with mucous impaction. Ann Allergy. 1991; 67:324–30.

5. Fick RB Jr, Baltimore RS, Squier SU, Reynolds HY. IgG proteolytic activity of Pseudomonas aeruginosa in cystic fibrosis. J Infect Dis. 1985; 151:589–98.

6. Costabel U, Bross KJ, Guzman J, Nilles A, Ruhle KH, Matthys H. Predictive value of bronchoalveolar T cell subsets for the course of pulmonary sarcoidosis. Ann N Y Acad Sci. 1986; 465:418–26.

7. Verstraeten A, Demedts M, Verwilghen J, van den Eeckhout A, Marien G, Lacquet LM, et al. Predictive value of bronchoalveolar lavage in pulmonary sarcoidosis. Chest. 1990; 98:560–7.

8. Reynolds HY, Fulmer JD, Kazmierowski JA, Roberts WC, Frank MM, Crystal RG. Analysis of cellular and protein content of broncho-alveolar lavage fluid from patients with idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonitis. J Clin Invest. 1977; 59:165–75.

9. Kim HS, Moon SN, Cheong SW, Lee KH, Kim HT, Lee SM, et al. Analysis of bronchoalveolar lavage fluid cells from the patients of diffuse interstitial lung diseases. Tuberc Respir Dis. 1994; 41:604–15.

10. Pereira W Jr, Kovnat DM, Snider GL. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest. 1978; 73:813–6.

11. Credle WF Jr, Smiddy JF, Elliott RC. Complications of fiberoptic bronchoscopy. Am Rev Respir Dis. 1974; 109:67–72.

12. Strumpf IJ, Feld MK, Cornelius MJ, Keogh BA, Crystal RG. Safety of fiberoptic bronchoalveolar lavage in evaluation of interstitial lung disease. Chest. 1981; 80:268–71.

13. Turner-Warwick M, Haslam PL. Clinical applications of bronchoalveolar lavage. Clin Chest Med. 1987; 8:15–26.

14. Meyer KC. The role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med. 2004; 25:637–49.

15. Kim DS. Idiopathic pulmonary fibrosis and pulmonary fibrosis associated with collagen vascular disease: clinical features, bronchoalveolar lavage findings, and response to treatment. Korean J Med. 1988; 35:87–98.

16. Costabel U, Guzman J. Bronchoalveolar lavage in interstitial lung disease. Curr Opin Pulm Med. 2001; 7:255–61.

17. Veeraraghavan S, Latsi PI, Wells AU, Pantelidis P, Nicholson AG, Colby TV, et al. BAL findings in idiopathic nonspecific interstitial pneumonia and usual interstitial pneumonia. Eur Respir J. 2003; 22:239–44.

18. Welker L, Jorres RA, Costabel U, Magnussen H. Predictive value of BAL cell differentials in the diagnosis of interstitial lung disease. Eur Respir J. 2004; 24:1000–6.

19. Meyer KC, Soergel P. Variation of bronchoalveolar lymphocyte phenotypes with age in the physiologically normal human lung. Thorax. 1999; 54:697–700.

20. The BAL Cooperative Group Steering Committee. Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups. Am Rev Respir Dis. 1990; 141:169–202.

Table 1.

Final diagnosis in the group with interstitial lung disease (ILD)

Diagnosis	All patients (%)	Smokers (%)
IPF	55 (39.0)	18 (45.0)
BOOP	27 (19.1)	6 (15.0)
NSIP	16 (11.3)	3 (7.5)
CEP	13 (9.2)	6 (15.0)
HP	10 (7.1)	1 (2.5)
CTD	7 (5.0)	1 (2.5)
Sarcoidosis	6 (4.3)	2 (5.0)
AIP	3 (2.1)	1 (2.5)
Drug-induced alveolitis	2 (1.4)	1 (2.5)
Wegener's granulomatosis	1 (0.7)	0 (0.0)
Alveolar proteinosis	1 (0.7)	1 (2.5)
Total	141 (100.0)	40 (100.0)

Data are presented as n (%). Only current smokers at the time of diagnosis were analysed separately.

Abbreviations: IPF, idiopathic pulmonary fibrosis; BOOP, bronchiolitis obliterans organizing pneumonia; NSIP, nonspecific interstitial pneumonia; CEP, chronic eosinophilic pneumonia; HP, Hypersentivity pneumonitis; CTD, Connective tissue disease; AIP, acute interstitial pneumonia.

Table 2.

Cellular components and lymphocyte subsets of bronchoalveolar lavage fluid from patient groups with interstitial lung diseases (ILD)

	IPF	BOOP	NSIP	EP	HP	CTD	Sarcoidosis
N	55	27	16	13	10	7	6
Cell number (×10⁴ Cells/mL)	64.2±41.0	95.4±115.0	69.6±31.0	91.8±81.1	98.2±50.1	134.4±107.4	54.3±25.5
Neutrophils (%)^*	21.0±23.1	18.3±23	8.7±8.6	6.2±10.9	12.4±12.7	1.3±1.1	7.0±11.7
Lymphocytes (%)'	12.0±17.0	31.5±22.4	23.4±23.4	16.0±16.0	51.0±29.0	19.0±16.0	20.0±9.0
Eosinophils (%)'	4.9±6.2	4.2±4.7	4.3±5.8	32.0±30.0	3.0±4.0	2.1±4.2	0.8±1.2
Macrophages (%)^*	62.5±27.1	46.2±24.9	63.6±26	48.2±28.6	33.6±21.0	45.3±29	72.2±14.7
T cells (%)^*	83.3±12.6	88±8.9	89.8±5.4	90.2±4.5	93.4±4.2	77.4±13.6	88.8±8.9
B cells (%)^*	3.1±3.9	1.8±1.9	2.1±2.3	1.6±1.8	1.5±2.5	4.3±3.6	1.0±2.0
CD4+ T (%)^†	41.0±15.3	38.7±17.7	23.6±15.4	57.5±14.0	41.6±26.1	31.9±16.6	59.2±17.3
CD8+T (%)^†	36.0±17.0	44.3±20.4	52.7±18.3	26.4±8.9	48.8±26.2	35.4±13.1	24.8±19.9
CD4/CD8^†	2.1±4.3	1.4±1.6	0.8±0.7	2.6±1.2	2.1±3.3	1.0±0.6	3.6±2.2
NK cells (%)^*	12.1±12.1	8.3±9.3	6.6±4.3	5.5±2.1	2.6±2.6	15.6±12.7	7.3±6.6

Each value was presented as mean ±SD.

^* P<0.05, statistically significant difference between groups;

^† P<0.001, statistically significant difference between groups.

Abbreviations: See Table 1.

Table 3.

Comparison of cellular components and lymphocyte subsets of BAL fluid from three major ILD patient groups according to the age

Age	IPF		BOOP			NSIP
Age	37–62	63-	19–36	37–62	63-	37–62	63-
N	20	35	2	11	14	10	6
Cell number (×10⁴ Cells/mL)	53.6±32.8	70.6±44.4	67.5±36.1	66.8±34.9	117.8±149.5	67.5±37.3	73.2±18.8
Neutrophils (%)	18.7±22.8	22.4±24.2	5.5±4.9	16.3±23	21.6±24.6	8.8±10.1	8.5±6.1
Lymphocytes (%)	9.9±11.2	13.4±20.4	47.5±4.9	34.6±23.9	27.1±22.3	25.9±27.1	19.3±17
Eosinophils (%)	6.7±7.8	3.8±4.7	2.5±3.5	5.3±4.5	3.7±5.1	2.2±2	7.8±8.3
Macrophages (%)	64.9±27.2	61±27.4	45±14.1	44.2±24.8	47.7±27.4	63.1±29.7	64.3±21
T cells (%)	85.8±12.3	81.9±12.8	90.5±0.7	84.7±11.7	90.3±6.1	91.1±4.1	87.7±7
B cells (%)	2.5±2.6	3.4±4.5	2±1.4	1.4±1.4	2.1±2.3	2±2.3	2.2±2.6
CD4+ T (%)	38.8±17.4	42.3±14.1	36±19.8	41.6±17.6	36.8±18.6	34.3±15.8	29.7±15.8
CD8+ T (%)	40.3±18.4	33.5±15.9	48.5±27.6	39.1±19.2	47.9±21.2	51.1±18.2	55.3±20
CD4/CD8	1.3±0.9	2.5±5.4	1±1	1.7±1.8	1.3±1.5	0.9±0.8	0.7±0.6
NK cells (%)	10.4±12.9	13.1±11.7	6.5±2.1	11.8±12	5.9±6.5	6.6±2.7	6.7±6.6

Each value was presented as mean±SD.

Abbreviations: See Table 1.

Table 4.

Comparison of cellular components and lymphocytes subsets of BAL fluid from three major ILD patient groups according to smoking habit

	IPF		BOOP		NSIP
	S	NS	S	NS	S	NS
N	18	37	6	21	3	13
Cell number (×10⁴ Cells/mL)	63.8±44.9	64.3±39.5	130.7±236.7	84.3±37.6	66±22.1	70.5±33.4
Neutrophils (%)	18.5±26.7	22.2±22.2	32.7±36.6	14.1±16	3.7±2.3	9.8±9.2
Lymphocytes (%)	12.4±21	11.9±15.6	21.2±14.5	34.7±23.7	3±1	28.2±23.6
Eosinophils (%)	4.7±7.7	5±5.4	3.5±3.9	4.5±5	0.3±0.6	5.2±6.1^*
Macrophages (%)	65.2±32.6	61.1±24.4	43±31.6	47.1±23.5	93±3.5	56.8±24.1^*
T cells (%)	82.8±14.7	83.5±11.7	84.3±11.9	89.1±7.8	91±2.6	89.5±5.9
B cells (%)	3.2±4	3±4	2.2±1.5	1.7±2.1	2.3±2.1	2±2.4
CD4+ T (%)	38.9±16.2	42.1±15	30.2±11.5	41.1±18.6	37.7±8	31.4±16.7
CD8+ T (%)	34.9±13.9	36.5±18.5	44.6±26.2	44.3±19.2	46.3±6.7	54.2±20
CD4/CD8	1.4±1	2.4±5.2	1.1±1.1	1.5±1.7	0.9±0.3	0.8±0.8
NK cells (%)	12.6±14.6	11.8±10.9	12.3±12	7.2±8.3	6.7±1.5	6.6±4.8

Each value was presented as mean±SD.

^* P<0.05, statistically significant difference between smokers and non-smokers.

Abbreviations: S, Smokers; NS, Non-Smokers; See Table 1 for the others.

Table 5.

Comparison of cellular components and lymphocytes subsets of BAL fluid in male and female

	IPF		BOOP		NSIP
	Female	Male	Female	Male	Female	Male
N	14	41	12	15	8	8
Cell number (×10⁴ cells/mL)	54.4±36.6	67.2±41.8	89.4±33.3	99.4±148.1	69.1±36.6	70.1±26.8
Neutrophils (%)	30±29.6	19.3±22.5	16.7±18.1	19.5±26.5	11±11	6.4±5.1
Lymphocytes (%)	12.4±13.3	12.2±18.6	43.1±25.5^*	23.1±15.8	20.1±20.4	26.8±27.1
Eosinophils (%)	7.9±6.5	3.9±5.8^*	4.2±4.2	4.3±5.2	5.6±7.2	3±4
Macrophages (%)	54.4±26.4	65.2±27.1	36.3±17.9	53.4±27.4	63.3±23.8	63.9±29.8
T cells (%)	82.1±10.9	83.7±13.3	88.5±10	87.7±8.1	91.5±4.8	88.1±5.8
B cells (%)	4.5±5.8	2.6±3	1.4±2	2.1±1.8	1.6±2	2.5±2.7
CD4+ T (%)	37.9±15.2	42.1±15.4	44.1±22.5	34.4±11.8	33±17.9	32.1±13.7
CD8+ T (%)	39.6±21.3	34.8±15.4	40.8±23.2	47.2±18.2	54.9±22.6	50.5±14
CD4/CD8	3.4±8.4	1.7±1.4	2±2.1	1±0.8	0.9±0.9	0.8±0.6
NK cells (%)	11.9±10.7	12.1±12.7	8.8±10.5	8±8.5	5.9±3.6	7.4±5.1

Each value was presented as mean±SD.

^* P<0.05, statistically significant difference between male and female.

Abbreviations: See Table 1.

TOOLS

Similar articles