We report 50 immunocompromised patients with pulmonary infiltrates who underwent fibreoptic bronchoscopy, including bronchoalveolar lavage, on 56 occasions. The underlying diseases were mostly lymphoma, leukemia, other malignancies and renal failure. The commonest immunodeficiency factors were chemotherapy, steroids and neutropenia. A positive diagnosis could be made from analysis of the bronchoalveolar lavage on 59% (33/56) occasions. This was a comparable yield to transbronchial lung biopsy 57% (16/27), and superior to proximal airways wash 24% (13/55), or bronchial brushings 29% (10/34). Open lung biopsy added additional diagnostic information in three of the four cases in which it was performed. The most common final diagnoses were bacterial, viral or Pneumocystis carinii pneumonia and recurrent malignancy. We conclude that bronchoalveolar lavage is a safe procedure with a high diagnostic yield in the immunocompromised host with suspected opportunistic pneumonia.

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(1978). Thorax, 33,[394][395][396][397][398][399][400] Acute changes of lung volumes and lung mechanics in asthma and in normal subjects. Lung volumes, pulmonary mechanics, and specific airway conductance (sGaw) were studied before and 15 minutes after 200 ,ug of aerosol salbutamol in nine asthmatics undergoing mild spontaneous exacerbations of their disease and in five normal subjects. In addition, three of the normal subjects were studied after voluntarily breathing at high lung volumes for one minute.The normal subjects and four of the asthmatics showed no overall changes in lung volumes or pressure-volume (PV) curves after salbutamol, even though airway dilatation was produced in the asthmatic subjects. In another five asthmatics, salbutamol induced a significant fall in the total lung capacity (TLC) in three, and in the residual volume and functional residual capacity in all five. There was a significant displacement of the PV curve downwards and to the right in all five, with increased lung compliance (Cl stat) in two.The fall in TLC could be accounted for by the increase in lung elasticity. There is reason to believe that this change in lung mechanics could be due to the reversal of asthma-induced stress relaxation.Sustained breathing at high lung volume is known to cause stress relaxation of the lung. However, this breathing pattern did not alter the PV curve or TLC in two of three normal subjects, which is consistent with stress relaxation being rapidly reversible. The other normal subject had an acute shift of the PV curve upwards and to the left after breathing at high lung volume. It has been concluded that stress relaxation is usually rapidly reversed but that in some individuals it may only be slowly reversed. This more persistent form of stress relaxation may contribute to the acute changes of TLC found in some asthmatics.

In ten adult patients with severe, partially reversible airflow obstruction due to asthma, with or without co-existent chronic bronchitis, the acute bronchodilator responses of ipratropium bromide (40 micrograms) and terbutaline (500 micrograms) from metered-dose inhalers, atropine methonitrate (2 mg) as a wet aerosol and placebo were compared in a double blind trial. Also the combination of ipratropium bromide and terbutaline aerosols was compared with both ipratropium and terbutaline alone in short-term and long-term studies. In the short-term study, all the drugs produced significant bronchodilatation compared with placebo. The responses to ipratropium bromide and terbutaline alone were not significantly different. The combination of ipratropium bromide with terbutaline did not produce significantly greater changes in the FEV1, SGaw or static lung volume than terbutaline alone. Atropine methonitrate however, produced significantly greater changes of the airway conductance (SGaw) and static lung volumes (TLC and RV) but not FEV1, when compared to ipratropium bromide. When administered over randomised periods of one month each there were no significant differences between the combination of ipratropium bromide and terbutaline and each drug alone in daily airflometer recordings, daily symptom scores or fortnightly spirometry and clinical assessment. It is concluded that ipratropium bromide, in the conventional dose of 40 microgramm by metered-dose inhaler produces safe, effective bronchodilatation. Its effect, however, did not significantly augment that of the beta adrenergic stimulant, terbutaline and was less than that of atropine methonitrate 2 mg by wet aerosol.

Two patients were suspected of having extrinsic allergic alveolitis due to exposure to an agent in their home environment. On inspection of their houses, fungal decay was evident in the floorboards, and fungal spores were found deposited on many surfaces. The decay fungus was later identified as Leucogyrophana pinastri. Using an extract of the fruiting bodies and mycelium of this fungus, precipitating antibodies were identified in the sera of both patients. Based on the known exposure by the two patients to these small spores, the absence of a likely alternative allergen, the similarity between these two cases, and the positive precipitin test results, L. pinastri was considered to be the most likely cause of extrinsic allergic alveolitis in our cases.