Bronchoalveolar lavage fluid cell counts in cryptogenic fibrosing alveolitis and their relation to therapy.

Abstract

Bronchoalveolar lavage was used to sample inflammatory cells from the lungs of 51 patients with cryptogenic fibrosing alveolitis (CFA) (24 smokers, 12 ex-smokers, and 15 non-smokers). The smokers with CFA have been compared with 15 smoking control subjects in whom there was no radiographic abnormality or clinical evidence of chronic bronchitis. Significantly lower volumes of lavage fluid were recovered from the smokers with CFA (p < 0 001) and the fluid contained lower percentages of macrophages (p < 0Ol), reflecting increased percentages of eosinophils (p < 000l) and neutrophils (p < 0 01). Similar changes were seen in the ex-smokers and non-smokers. There was also an increase in the percentages of lymphocytes when the whole group of CFA patients was compared with the control subjects (p < 0 05). No significant differences were found when patients with "lone" CFA were compared with those having associated systemic disease. The only feature distinguishing smokers from non-smokers with CFA was the presence of pigmented cytoplasmic inclusions in the macrophages from the smokers (p < 0 001). However, there were lower numbers of pigmented macrophages in the smoking CFA patients by comparison with the control subjects suggesting either a change in phagocytic capacity or turnover rate in this disease. Profiles of differential cell counts in individual patients showed that increases of eosinophils over 30% or neutrophils over 40% or both with lymphocyte counts of less than 11 0% related to a poor clinical response to corticosteroids, but lymphocyte percentages greater than 11°/ , related to improvement (p < 0 05).Earlier studies have shown that the cell populations of bronchoalveolar lavage fluids in normal volunteers are mainly alveolar macrophages with small numbers of lymphocytes

Comparison of cell profiles on bronchial and bronchoalveolar lavage fluids between normal subjects and patient with idiopathic pulmonary fibrosis.

“…The mean percentage of neutrophils in our patients with IPF was much lower than the values reported by Reynolds et al (1977, 33%) and Weinberger et al (1978, 21.3%), but is comparable to that reported by Haslam et al (1980). The mean percentage of eosinophils in our study was comparable to that reported by Reynolds et al (1977) and Weinberger et al (1978).…”

“…On the other hand, Reynolds et al (1977) and Weinberger et al (1978) reported that the percentage of lymphocytes in the BALF of patients with IPF was not increased. Other investigators (Haslam et al 1980 ;Ozaki et al 1982) reported that it was only slightly increased in some patients with IPF.…”

“…It also tended to be lower for smokers with IPF than for those of OP group. Previous investigators (Reynolds et al 1977;Haslam et al 1980) reported that the R value was, or tended to be, lower in patients with IPF than in control patients. As regards BL, however, the R value of IPF group was similar to that of CP group.…”

“…It has been reported (Reynolds et al 1977 ;Weinberger et al 1978 ;Haslam et al 1980 ;Hunninghake et al 1981;Rudd et al 1981) that the BALF of patients with IPF contains more polymorphonuclear leukocytes, especially neutrophils and eosinophils, than that of age-matched control patients. On the other hand, Reynolds et al (1977) and Weinberger et al (1978) reported that the percentage of lymphocytes in the BALF of patients with IPF was not increased.…”

“…Previous investigators (Reynolds et al 1977;Weinberger et al 1978;Haslam et al 1980) have reported that an increase of polymorphonuclear leukocytes, especially neutrophils, in the bronchoalveolar lavage fluid (BALF) is characteristic of patients with IPF. Neutrophils have also been considered to be closely related to…”