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

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In vitro studies of T-lymphocyte responses using five different batches o^ Aspergillus fumigatus antigens, were undertaken in twelve patients with A. fumigatus related lung disease and in three normal controls.Using a leucocyte migration method, five of the twelve patients showed significant inhibition of leucocyte migration with a migration index of 0-80 or less to A. fumigatus, but in only three was this demonstrated with more than one batch of antigen (one patient with aspergilloma and two with bronchopulmonary aspergillosis).The same antigens were used in lymphocyte transformation tests. Only two patients, one with aspergilloma and one with bronchopuhiionary aspergillosis, showed clearly significant transformation although there were several borderline results.Only three patients had evidence of delayed skin responses to /(./u/«/ga/wi antigens in vivo, one with aspergilloma, one with bronchopulmonary aspergillosis and one with atypical bronchopulnionary aspergillosis. Two of these three patients also had one or more positive in vitro test results.Thus T-lyniphocyte sensitization to A. fumigatus as demonstrated by these //; vitro methods, although present in occasional patients, was not clearly related to any one particular clinical syndrome in this small group of patients with aspergillus related pulmonary disease. There was, however, one of the three aspergilloma patients with positive lymphocyte transformation to all five batches of antigens and having higher transformation indices than in any other patient. This suggests that lymphocyte studies should be extended in this group.In contrast to the frequent negative results using A. futnigatus antigens, evidence of T-lymphocyte sensitization to either Candida albicans or Mycobacterium tuberculosis or both, was shown by positive delayed hypersensitivity skin responses and in vitro inhibition of leucocyte migration in the majority of the patients, despite which lymphocyte transformation was often negative. The possibility of impaired capacity to transform is supported by the finding of an impaired response to phytohaemagglutinin (PHA) in four of the twelve cases. Correspondence; Professor M. Turner-Warwick, Cardiothoracic Itistitule Brompton Hospital, London SW3. F 277 278 P. Haslam et al.This information, together with other data discussed, helps to complete the contrasting immunological proliies seen in different Aspergillus fumigatus related lung diseases.