Bronchoalveolar lavage was performed on 12 healthy volunteers, comprising 6 smokers and 6 nonsmokers, of ages between 21 and 52 years. The aim was to define normal variability of certain biochemical, immunologic, enzymologic and ionic parameters. The smoking habit was observed to exert a significant influence on the recovery percentage of lavage effluents (with recovery less in smokers, 53 vs. 69%) and particularly on the concentration of immunoglobulins in the lavage liquids. In particular, the IgG increased by about 4 times in smokers (1.05 vs. 0.26 mg/100 ml) and the IgA by about 3 times (0.35 vs. 0.11 mg/100 ml). The other parameters studied (total proteins, albumins, IgM, α1-AT, K, Ca and several enzyme activities) did not differ significantly from one group to the other. Rather than an alteration in the blood-alveolar barrier from smoking, these data suggest a real local overproduction of immunoglobulins of classes G and A induced by the smoking habit. Moreover, the relatively slight individual oscillation in the values of the parameters studied in the two groups supports the possibility of employing them for diagnostic purposes in bronchopneumopathies
Twenty-three patients suffering from lower respiratory tract infections caused by Gram-negative germs were treated with aztreonam (AZT) administered according to two different regimens: 17 subjects (Group A) with 2 g i.v. every 12 h and 6 patients (Group B) with 4 g in 100 ml of saline every 24 hours. Group A included 8 cases of superinfected bronchiectasis, 8 purulent bronchitis and 1 gangrene caused by Gram-negative and anaerobic agents. Group B comprised 6 patients with severe bronchiectasis infection. Pseudomonas aeruginosa was isolated from the sputum in 10/23 cases. The treatment was performed for 10 days on the average. The local and systemic tolerability was good. Group B, with higher antibiotic sputum concentrations for at least 12 hours, attained a better response than Group A: with clinical cure in 100% vs 76% cured plus 18% improved patients; therapy lasted 9.5 days for Group B vs 10.8 days for Group A. Moreover, in 14 subjects affected by pulmonary interstitial diseases who underwent diagnostic broncho-alveolar lavage, we dosed AZT in lavage fluids about 1 hour after the injection of a 2 g dose (Group C: 8 cases) or a 4 g dose (Group D: 6 cases). In group D antibiotic concentrations were significantly higher (P less than 0.005) than group C, while all the parameters that usually define the intensity of the alveolar alterations were not significantly different. Therefore, aztreonam administration in a daily monodose seems able to assure higher and longer lasting concentrations at the site of infection.
Bronchoalveolar lavage, performed on 15 healthy volunteers, enabled quantification and characterization of the alveolar cell populations. The subjects studied were 8 nonsmokers (5 males, 3 females) and 7 smokers (6 males, 1 female). It was found that in the smokers the macrophages increased compared with nonsmokers, both in absolute number (419,000 vs. 138,000/ml; p < 0.005) and in percentage (93.8 ± 3.0 vs. 88.1 ± 4.8%; p < 0.02), causing a significant increase in the total number of cells recovered after bronchoalveolar lavage (471,000 vs. 163,000/ml; p < 0.005). Lymphocytes and neutrophils do not significantly vary in the two groups, even though among the smokers there is a tendency for the concentration of these cells to increase in the lavage liquids. The importance of the data obtained from healthy subjects lies in the possibility thus afforded of having reference values for the study of various lung pathologies with bronchoalveolar lavage
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