When used in conjunction with comprehensive clinical information and adequate thoracic imaging such as high-resolution computed tomography of the thorax, BAL cell patterns and other characteristics frequently provide useful information for the diagnostic evaluation of patients with suspected ILD.

Fibrosing alveolitis associated with systemic sclerosis (FASSc) has a better prognosis than idiopathic pulmonary fibrosis. In view of recent reports that idiopathic nonspecific interstitial pneumonia (NSIP) has a better prognosis than idiopathic usual interstitial pneumonia (UIP), we classified histologic appearances of surgical lung biopsies performed in 80 patients with FASSc. NSIP (n = 62, 77.5%), subcategorized as cellular NSIP (n = 15) and fibrotic NSIP (n = 47) was much more prevalent than UIP (n = 6), end-stage lung disease (ESL, n = 6), or other patterns (n = 6). There were 25 deaths (NSIP 16/62, 26%; UIP/ESL 6/12, 50%). Five-year survival differed little between NSIP (91%) and UIP/ESL (82%); mortality was associated with lower initial carbon monoxide diffusing capacity (DL(CO)) and FVC levels (p = 0.004 and p = 0.007, respectively). Survival and serial FVC and DL(CO) trends did not differ between cellular and fibrotic NSIP. Increased mortality in NSIP was associated with lower initial DL(CO) levels (p = 0.04), higher BAL eosinophil levels (p = 0.03), and deterioration in DL(CO) levels during the next 3 years (p < 0.005). We conclude that NSIP is the histopathologic pattern in most patients with FASSc. However, outcome is linked more strongly to disease severity at presentation and serial DL(CO) trends than to histopathologic findings.

The investigatory technique of bronchoalveolar lavage (BAL) has become one of the most valuable research tools for studying inflammatory mechanisms in a wide range of diseases that affect the lungs and airways in humans, and several thousand peer review papers are published each year. In addition, cytological and microbiological testing of BAL samples are of established value for assisting in clinical diagnosis and management of many lung diseases, and these procedures are available routinely in most modern specialist respiratory centres. Yet despite its undoubted value, the interpretation of BAL findings is still hindered because the procedure cannot be precisely standardized. In particular, there is still no satisfactory method of determining the dilution factor during lavage. This prevents accurate quantification of all components in BAL fluids and causes especial difficulty in interpreting the results of measurements of soluble acellular components.A number of Task Force reports have been published that have provided guidelines for the clinical application of BAL, and on technical aspects mainly related to evaluation of cells and other cytological features [1±4]. However, no guidelines are currently available for evaluation of acellular components, nor are any firm recommendations available for standardization of BAL procedure. The purpose of this editorial is to inform that this omission is now addressed by a new report of a European Respiratory Society (ERS) Task Force which is currently being published in the European Respiratory Review [5]. This Report provides a comprehensive review of the current status of techniques for measurement of acellular components in human BAL samples, and gives guidelines and recommendations to define standard procedures for the general conduct of BAL. It updates previous guidelines and gives recommendations on how to comply with the increasing demands for more effective quality control.The Task Force was established by the BAL Scientific Group of the ERS in September 1995. The authors were privileged to be the task force co-ordinators and editors of the report, to which 49 authors and 21 invited reviewers from 15 countries contributed. It contains a series of detailed critical reviews which give recommendations according to the consensus view on 17 topics. These include three sections concerned with the general problems of BAL standardization [6±8] and one section dealing with the special problems relating to children [9]; while the remaining 13 sections provide detailed information on specific considerations that apply to the measurement of different categories of specific components including pulmonary surfactant components [10] [21], and other acellular components [22]. Those beginning work on lavage will find information about problems and pitfalls and how best to avoid them, while those experienced in the field will find comprehensive critical reviews to assist with selecting optimal approaches. All are encouraged to agree to the recommendations for better standardizati...