Bronchoalveolar lavage in occupational lung diseases

Our plain-English summary of Bronchoalveolar lavage in occupational lung diseases, by C.R. Cordeiro, J.C. Jones, T. Alfaro, et al (Seminars in Respiratory and Critical Care Medicine, 2007).

The study

• Authors: C.R. Cordeiro, J.C. Jones, T. Alfaro, A.J. Ferreira
• Journal: Seminars in Respiratory and Critical Care Medicine
• Published: 2007;28(5):504-13
• Type of article: Review
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Occupational lung diseases (OLDs) are related to the exposure and inhalation of organic, inorganic, and synthetic particles, fumes, gases, or infectious agents. From the long list of OLDs this article focuses the discussion on bronchoalveolar lavage (BAL) in parenchymal immunoinflammatory conditions, such as hypersensitivity pneumonitis (HP) and pneumoconiosis. Several antigens may cause HP, including products of plant or animal origin, aerosolized microorganisms, and organic chemicals. BAL is used not only to assess the pathogenesis of these diseases but also to identify the typical pattern of intense lymphocytic alveolitis, usually with a CD4:CD8 ratio below normal and frequently with the presence of mast cells, plasma cells, and foamy macrophages. Pneumoconioses are chronic interstitial lung diseases caused by the inhalation of mineral and metallic inorganic particles/dusts in an occupational setting, showing a decreasing prevalence in recent years. BAL is a useful tool not only to express the complex pathogenic mechanisms of these entities but also in excluding other diagnoses and causes of alveolitis, and to document specific exposures, such as the identification of asbestos bodies (ABs) in asbestosis or the proliferative response of BAL lymphocytes to beryllium in chronic beryllium disease (CBD).

In plain English

This article was a review of how bronchoalveolar lavage (BAL) is used in occupational lung diseases. BAL is a procedure that washes fluid into the lung and collects cells and particles. The review focused on hypersensitivity pneumonitis and on pneumoconioses, which include asbestosis, silicosis and chronic beryllium disease. The authors, from Coimbra, Portugal, also looked back at the last 20 consecutive patients with hypersensitivity pneumonitis and the last 20 with pneumoconioses of different causes who had BAL at their research centre. In the pneumoconiosis patients they found a less intense alveolitis (inflammation in the lung's air sacs) than in the hypersensitivity pneumonitis patients, with a mixed lymphocytic/granulocytic pattern. They described one case: a 64-year-old non-smoking man who had worked for 9 years in France in contact with asbestos in a factory of thermal isolation materials. He had progressive breathlessness and fatigue. Asbestos bodies were found in his BAL fluid at 1.6 per mL. The authors concluded that identifying and counting these asbestos bodies was essential to confirm his diagnosis. They also wrote that negative BAL findings do not exclude increased asbestos bodies in lung tissue.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review, including the authors' own retrospective analysis of BAL data from consecutive patients and two illustrative case reports
• Who was studied: Own data: the last 20 consecutive patients with hypersensitivity pneumonitis and the last 20 consecutive patients with pneumoconioses of different causes who had BAL at the Research Centre of Pulmonology, University of Coimbra, Portugal (dates not given). The asbestos case was a 64-year-old male non-smoker.
• Exposure: The review covered organic antigens (hypersensitivity pneumonitis) and mineral and metal dusts (pneumoconioses), including asbestos, crystalline silica and beryllium. In the asbestos case: 9 years of work in contact with asbestos in a factory of thermal isolation materials in France. No fiber type was given for this case.
• Main results:
  • In the 20 consecutive hypersensitivity pneumonitis patients, the authors confirmed a lymphocytic alveolitis with diminished CD4:CD8 values.
  • In the 20 consecutive pneumoconiosis patients, the alveolitis was less intense than in the hypersensitivity pneumonitis patients and had a mixed lymphocytic/granulocytic pattern.
  • Asbestos case: the man had progressive breathlessness and fatigue, a restrictive pattern on lung function testing, and a ground-glass pattern on HRCT scan, mainly in the lower lobes.
  • Asbestos case: his BAL showed 82.4% macrophages, 16.3% lymphocytes, 0.8% eosinophils and 0.5% neutrophils. Asbestos bodies were identified at 1.6 per mL of BAL fluid, including a fiber taken up by a macrophage.
• The authors' conclusion: The authors concluded that the case illustrated a lung disorder related to occupation and to working with asbestos, and that identifying and counting asbestos bodies in BAL fluid was essential to confirm the diagnosis. More broadly, they described BAL as useful for excluding other diagnoses and documenting specific exposures. They also stated that negative BAL findings do not exclude increased asbestos body content in lung tissue.

Topics

Medical terms in this study, explained in our Lexicon: Bronchoalveolar Lavage (BAL), Occupational Lung Disease, Pneumonitis, Pneumoconiosis, Macrophage, Interstitial Lung Disease, Asbestos Bodies.

Related studies

• Multinuclear giant cells in bronchoalveolar lavage in interstitial lung diseases — C. Agustí, A. Xaubet, et al. (1987)
• Assessment of hazardous dust exposure by BAL and induced sputum — E. Fireman, J. Greif, et al. (1999)
• T-cell alveolitis in lung lavage of asbestos-exposed subjects — N.L. Sprince, L.C. Oliver, et al. (1992)
• Influence of cigarette smoking on bronchoalveolar lavage cellularity in asbestos-induced lung disease — D.A. Schwartz, J.R. Galvin, et al. (1992)
• Imaging of Occupational Lung Disease — J. Champlin, R. Edwards, et al. (2016)
• Asbestos bodies in bronchoalveolar lavage in the 21st century: a time-trend analysis in a clinical population — V. Nuyts, H. Vanhooren, et al. (2017)

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