BAL findings in idiopathic nonspecific interstitial pneumonia and usual interstitial pneumonia.
Idiopathic pulmonary fibrosis (IPF), which has the histological pattern of usual interstitial pneumonia (UIP), is a progressive interstitial lung disease with a poor prognosis. Idiopathic interstitial pneumonias with a histological pattern of nonspecific interstitial pneumonia (NSIP) have a better prognosis than UIP, and may present with a clinical picture identical to IPF. The authors hypothesised that bronchoalveolar lavage (BAL) findings may distinguish between UIP and NSIP, and have prognostic value within disease subgroups. BAL findings were studied retrospectively in 54 patients with histologically proven (surgical biopsy) idiopathic UIP (n=35) or fibrotic NSIP (n=19), all presenting clinically as IPF. These findings were also compared with the BAL profile of patients with other categories of idiopathic interstitial pneumonias. BAL total and differential cell counts did not differ between the two groups. Survival was better in NSIP. In neither group were BAL findings predictive of survival or changes in lung function at 1 yr, even after adjustment for disease severity, smoking and treatment. BAL differential counts in fibrotic NSIP differed from respiratory bronchiolitis-associated interstitial lung disease, but not from desquamative interstitial pneumonia or cellular NSIP. The authors conclude that bronchoalveolar lavage findings do not discriminate between usual interstitial pneumonia and nonspecific interstitial pneumonia in patients presenting with clinical features of idiopathic pulmonary fibrosis, and have no prognostic value, once the distinction between the two has been made histologically.
Veeraraghavan
S
S
Interstitial Lung Disease Unit, Dept of Occupational and Environmental Medicine, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College of Science Technology and Medicine, London, UK.
Latsi
P I
PI
Wells
A U
AU
Pantelidis
P
P
Nicholson
A G
AG
Colby
T V
TV
Haslam
P L
PL
Renzoni
E A
EA
du Bois
R M
RM
D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011658:Pulmonary Fibrosis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects