Bronchoalveolar lavage in pulmonary fibrosis: comparison of cells obtained with lung biopsy and clinical features

Our plain-English summary of Bronchoalveolar lavage in pulmonary fibrosis: comparison of cells obtained with lung biopsy and clinical features, by P.L. Haslam, C.W. Turton, B. Heard, et al (Thorax, 1980).

The study

• Authors: P.L. Haslam, C.W. Turton, B. Heard, A. Lukoszek, J.V. Collins, A.J. Salsbury, M. Turner-Warwick
• Journal: Thorax
• Published: 1980;35(1):9-18
• Cited by: 246 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Bronchoalveolar lavage, open lung biopsy, and cell extraction from the biopsy material have been studied in 21 symptomatic patients with progressive pulmonary fibrosis (18 with cryptogenic fibrosing alveolitis, fulfilling also the criteria for “usual interstitial pneumonia” (UIP), and three with rapidly progressive disease probably related to asbestos exposure). The total and differential cell counts between the three different samples have been compared as well as the influence on them of smoking and their correlation with steroid responsiveness and later progress. There was no correlation between semiquantitative scores of cell types observed within alveolar spaces and in alveolar walls and the differential or total cell counts obtained from extraction or lung lavage samples. There was, however, some correlation between differential counts obtained from lung lavage and extractions (neutrophils p<0·02, eosinophils p<0·07, lymphocytes p<0·08) suggesting that lung lavage reflects the cellularity of the peripheral parts of the lung in patients without overt bronchial disease. Steroid responsiveness related to the percentage of lymphocytes found in extraction samples (p<0·01) and was associated with a complementary fall in the percentage of macrophages (p<0·02). There was no relationship between steroid response and the numbers of neutrophils or eosinophils in extracted samples. There was a trend towards increased numbers of lymphocytes in the lung wash in those patients responding to steroids. Those cases showing more rapid progression before starting treatment tended to have higher percentages of lymphocytes, neutrophils, or eosinophils in the lung lavage than more slowly deteriorating cases (p<0·01). Follow-up studies showed that three cases having predominant lymphocytes in the lung lavage continued to do well while nine cases with predominant neutrophils or eosinophils or both showed a less satisfactory response to steroids and often deteriorated. Differential cell counts from biopsy extractions and lung lavage may give information additional to conventional light microscopy on the likelihood of steroid responsiveness as well as providing some measure of the activity of disease.

In plain English

This study, from the Brompton Hospital in London, compared cells collected by bronchoalveolar lavage (washing the lung through a bronchoscope) with biopsy findings in 21 patients with progressive pulmonary fibrosis, and with cells extracted from the biopsies of 12 of them. Eighteen had cryptogenic fibrosing alveolitis. Three had rapidly progressing lung disease with asbestos exposure and an uncertain diagnosis, and asbestos bodies were found in their biopsies. Neutrophil percentages in lavage and biopsy extracts were correlated (p less than 0.02), but scores from biopsy sections did not correlate with lavage counts. A higher lymphocyte percentage in biopsy extracts was related to response to steroids (p less than 0.01). The three patients whose lavage showed mainly excess lymphocytes all responded and stayed improved. Of nine with excess neutrophils or eosinophils, four responded but none kept the improvement, and two deteriorated rapidly. None of the three asbestos-exposed patients showed increased lavage lymphocytes or responded to steroids. The authors said only provisional conclusions should be drawn. They added that whether these three patients' disease could be attributed to asbestos exposure remained a matter for conjecture.

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: Clinical comparison study of bronchoalveolar lavage, lung biopsy, and cell extraction from biopsy tissue (possible in 12 patients), with assessment of response to a trial of corticosteroids and later progress
• Who was studied: 21 patients at the Brompton Hospital, London (16 men, 5 women; mean age 48.9 years, range 34 to 62). 18 were previously untreated consecutive patients with cryptogenic fibrosing alveolitis. 3 additional patients had rapidly progressing pulmonary disease with asbestos exposure and a doubtful diagnosis. Cell extraction from biopsy tissue was done in 12 of the 17 open biopsies performed after lavage. Study dates are not given.
• Exposure: Three patients had asbestos exposure, and asbestos bodies were found in their biopsy specimens. No fiber type, job or dose is reported. The main comparisons were between cell types (macrophages, neutrophils, eosinophils, lymphocytes) in lavage, biopsy sections and biopsy extracts.
• Main results:
  • Cell extraction was possible in 12 of the 17 open biopsies performed after lavage.
  • Neutrophil percentages in biopsy extracts and lung lavage were significantly correlated (p less than 0.02). The correlation was possible for eosinophils (p less than 0.07) and suggestive for lymphocytes (p less than 0.08).
  • Semiquantitative biopsy scores did not correlate significantly with lung lavage counts for any inflammatory cell type.
  • In biopsy extracts, the percentage of lymphocytes was related to steroid responsiveness (p less than 0.01), with a fall in the percentage of macrophages (p less than 0.02).
  • In lung lavage, all patients with a lymphocyte count of 5% or greater responded to corticosteroid or immunosuppressant treatment, although lavage correlations did not reach conventional significance.
  • Patients who were increasingly breathless before the study had more inflammatory cells and proportionately fewer macrophages in lavage than those whose symptoms were unchanged (p less than 0.01).
  • The three patients with more than 5% lymphocytes, and fewer than 10% neutrophils or 5% eosinophils, all responded to steroids and their improvement was maintained. Of nine patients with increased neutrophils or eosinophils, four responded but none maintained improvement, and two deteriorated rapidly.
  • Smokers had greater total lavage cell counts than non-smokers (p=0.03).
  • The three asbestos-exposed patients were among the eight patients showing no improvement on steroids, and none showed an increase in lavage lymphocytes.
  • In the three asbestos-exposed patients, biopsies showed a moderate or marked increase in intra-alveolar large mononuclear cells and only minimal or moderate fibrosis.
• The authors' conclusion: The authors concluded, provisionally, that cell counts from lavage and biopsy extraction may help indicate the likelihood of steroid response and disease activity. They said that whether the three asbestos-exposed patients' disease can be attributed to asbestos exposure remains a matter for conjecture.
• Limitations the authors state:
  • The number of cases was small and only provisional conclusions should be drawn.
  • The asbestos-exposed group was too small for statistical analysis.
  • Clinical assessment of steroid responsiveness is very imprecise.
  • There was a very wide scatter of lavage counts between individual patients.
  • The four-point scale and the difficulty of counting cells in tissue sections likely limited the biopsy correlations.
  • In patients with bronchial disease, lavage should not be assumed to reflect only changes in the peripheral lung.

Topics

Medical terms in this study, explained in our Lexicon: Bronchoalveolar Lavage (BAL), Pulmonary Fibrosis, Biopsy, Interstitial, Asbestos Exposure, Macrophage.

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