BAL in the diagnosis of smoking‐related interstitial lung diseases: Review of literature and analysis of our experience

Abstract

The group of interstitial lung diseases (ILDs) is formed by respiratory tract disorders, whose aetiology is unknown in the majority of cases, the clinical course differs and the prognosis is generally serious. Some of the ILDs have a potential relation to tobacco smoking and are known as smoking-related ILDs (sr-ILD). Bronchoalveolar lavage fluid (BALF) examination is one of the initial procedures in the diagnosis of ILD. Despite the fact that histological confirmation is the gold standard in ILD diagnosis in many studies, the number of reported biopsies was low. In this review we present the results of BALF examinations of patients with sr-ILD and discuss their value in the differential diagnosis with other types of ILD. An extremely high total cell count (about 50 x 10(6) cells) with significant predominance of pigmented alveolar macrophages is a characteristic pattern of BALF in sr-ILD. The greatest challenge in BALF cytology interpretation is to distinguish sr-ILD and idiopathic pulmonary fibrosis (IPF). IPF is characterised by an elevated proportion and absolute count of lymphocytes and neutrophils; in addition, BALF lymphocytosis is higher in non-specific interstitial pneumonia than in usual interstitial pneumonia (UIP). The population of alveolar macrophage of patients with sr-ILD differs markedly from the foamy and vacuolated cells that predominate in IPF/UIP. Thus, the absence of pigmented cells rather excludes sr-ILD and indicates other types of ILD. To summarise, the place of BALF in the diagnosis of sr-ILD seems to be established.

Bronchoalveolar Lavage Total Cell Count in Interstitial Lung Diseases—Does It Matter?

“…In addition, it should be pointed that reporting cell proportions is, in fact, limited to showing relativity, and this may be misleading. A good example can be seen in our previous studies on sr-ILD [20]. The differential cell count in the BALF of patients with desquamative interstitial pneumonia/respiratory bronchiolitis ILD was in normal range, while the total count of macrophages was almost ten times higher than in normal BALF of nonsmoking subjects.…”

Cell Recovery in Bronchoalveolar Lavage Fluid in Smokers Is Dependent on Cumulative Smoking History

“…Cigarette smoking is also a risk factor for various lung diseases [19], [20], [21], [22] such as chronic obstructive pulmonary disease (COPD), usual interstitial pneumonia (UIP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis associated interstitial lung disease (RB-ILD) and pulmonary Langerhans cell histiocytosis (PLCH). Since these patients may undergo BAL as a part of a clinical investigation [19], [23], it is important to distinguish inflammatory changes due to cigarette smoking per se from changes due to the disease.…”

“…Since these patients may undergo BAL as a part of a clinical investigation [19], [23], it is important to distinguish inflammatory changes due to cigarette smoking per se from changes due to the disease. The establishment of a standardized reference material for BAL in asymptomatic smokers may contribute to a better interpretation and utility of this important diagnostic tool in a clinical framework.…”

Problems of Cancer Treatment. Part 2. Treatment Based on Modification of Anticancer Immunological Responses in Therapy

“…A pronounced immunomodulatory effect of tobacco smoke has been proven: it affects not only the respiratory system but it also induces systemic alterations [8,9]. In our own studies we found a significant effect of tobacco smoking on lesions in pulmonary environment: in BALs obtained from smokers a proportion of helper Th lymphocytes (CD4 + ) was reduced and that of cytotoxic Tc lymphocytes (CD8 + ) was increased.…”