Predictive Value of Bronchoalveolar Lavage in Pulmonary Sarcoidosis

Verstraeten, A; Demedts, Maurits; Verxvilghen, Jo; Eeckhout, A. Van den; Mariën, Godelieve; Lacquet, L M; Ceuppens, Jan L.

doi:10.1378/chest.98.3.560

Cited by 61 publications

(41 citation statements)

References 21 publications

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“…Since the 1980s, most researchers have focused their interest upon lymphocyte count and CD4/CD8 ratio may herald alleviation of the disease [5,17]. In other studies, neither the percentage of BALF lymphocytes nor the CD4/CD8 ratio was of predictive value [4,6].…”

Section: Discussionmentioning

confidence: 99%

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Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis

Ziegenhagen

Rothe²,

Schlaak³

et al. 2003

Eur Respir J

184

129

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The aim of the present study was to determine which bronchoalveolar lavage fluid (BALF) and serological parameters reflect the severity of newly diagnosed pulmonary sarcoidosis.Seventy-four previously untreated sarcoid patients were categorised into three groups: 10 patients with Löfgren9s syndrome, 51 patients with stable disease and 13 patients with progressing disease requiring systemic steroid treatment.Total BALF cell count, percentage of alveolar lymphocytes and lymphocyte CD4/ CD8 ratio were not associated with severity of disease. Interestingly, a significant increase in percentages of BALF neutrophils (5.2¡1.1%) and eosinophils (1.7¡0.6%) was observed in sarcoid patients with progressing disease. Elevated percentages of these two cell types were the only BALF parameters associated with a more frequent necessity for systemic steroid therapy. This association between an elevated percentage of BALF neutrophils and the necessity for steroid treatment was observed in advanced as well as early sarcoidosis (radiological types I and II). Serum levels of soluble interleukin-2 receptor and neopterin were significantly elevated in progressing disease compared to stable disease or Löfgren9s syndrome.The present results demonstrate that increased percentages of neutrophils (w3.0%) and eosinophils (w1%) in bronchoalveolar lavage fluid from newly diagnosed pulmonary sarcoidosis is associated with a significantly higher risk of necessity for steroid therapy and may be helpful markers of progressive disease. Furthermore, of the serological parameters investigated, only serum levels of soluble interleukin-2 receptor and neopterin were associated with disease severity. Eur Respir J 2003; 21: 407-413.

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Section: Discussionmentioning

confidence: 99%

“…Since the 1980s, several studies analysing the role of the percentage of BALF lymphocytes and the CD4/CD8 ratio have been performed with diverse results [4][5][6][7]. Since the late 1990s, however, there has been increasing evidence that neutrophilic alveolitis may play an important role in the outcome of sarcoidosis.…”

mentioning

confidence: 99%

Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis

Ziegenhagen

Rothe²,

Schlaak³

et al. 2003

Eur Respir J

184

129

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“…BAL lymphocytes >35 % predicted a good response to treatment, as indicated by an increase in FVC value in >90% of patients, whereas patients with low-intensity alveolitis deteriorated in 50% of cases, regardless of the treatment (Hollinger et al, 1985). Many authors did not find any differences in BAL lymphocytes content between subgroups of different prognosis as defined by radiological stage, chronicity or other factors (Vidal Serrano et al, 2005;Ziegenhagen et al, 2003); whereas some authors report higher intensity alveolitis in patients with stage I comparing to stage III (Danila et al, 2008;Verstraeten et al, 1990). Follow-up studies clearly show the lack of negative prognostic value of high lymphocyte content in BAL.…”

Section: Bronchoalveolar Lavage (Bal) Cellsmentioning

confidence: 95%

“…Follow-up studies clearly show the lack of negative prognostic value of high lymphocyte content in BAL. The recovery of lymphocytes in lavage fluid had no prognostic value for persistent disease in the over twoyear follow-up studies (Bjermer et al, 1988;Verstraeten et al, 1990). High content of CD4 lymphocytes or high CD4/CD8 ratio in BAL are more relevant markers of activity comparing to total lymphocyte BAL percentage (Costabel, 1998).…”

Section: Bronchoalveolar Lavage (Bal) Cellsmentioning

confidence: 99%

“…High content of CD4 lymphocytes or high CD4/CD8 ratio in BAL are more relevant markers of activity comparing to total lymphocyte BAL percentage (Costabel, 1998). Patients who improved radiologically had higher numbers of CD4 cells and higher CD4/CD8 ratio comparing to patients who deteriorated or remained unchanged (Verstraeten et al, 1990). Also, patients with higher CD4/CD8 at initial diagnosis responded better to treatment (Baughman et al, 1984;Płodziszewska et al, 2000).…”

Section: Bronchoalveolar Lavage (Bal) Cellsmentioning

confidence: 99%

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Prognostic Factors in Sarcoidosis

Piotrowski¹

2011

Sarcoidosis Diagnosis and Management

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T‐cell alveolitis in lung lavage of asbestos‐exposed subjects

Nl¹,

Lc²,

Tc³

et al. 1992

American J Industrial Med

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In sarcoidosis and idiopathic pulmonary fibrosis, it has been reported that lymphocyte proportions in lung lavage predict the subsequent clinical course. Recent evidence has suggested that lymphocytes are important in the alveolitis of asbestosis. We hypothesized that a greater relative proportion of T-lymphocytes in lung lavage of asbestos-exposed subjects is associated with immune activation and may predict the subsequent clinical course. We assessed lymphocyte subsets in lung lavage and peripheral blood (PB) of 97 asbestos-exposed subjects and 10 unexposed normal, using flow cytometry analysis of monoclonal antibody-treated cells. T-cell alveolitis was defined as follows: [%lymphocytes in lavage x %CD3 in lavage] greater than 2 SD above that product in normals. Eighteen subjects had T-cell alveolitis (group 1) and 79 did not (group 2). There were no significant differences between the groups in age, smoking status, duration of exposure, lung function results, or frequency of plaques or profusion greater than or equal to 1/0. Percent CD2 was higher in lavage of group 1 compared with group 2. There was a trend for higher %Ia in lavage of group 1 compared with group 2. These results identify a subgroup of asbestos-exposed subjects with T-cell alveolitis but no present excess of asbestos-related disease who may be at risk for future asbestos-related disease.

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Predictive Value of Bronchoalveolar Lavage in Pulmonary Sarcoidosis

Cited by 61 publications

References 21 publications

Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis

Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis

Prognostic Factors in Sarcoidosis

T‐cell alveolitis in lung lavage of asbestos‐exposed subjects

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