Comparison between Bronchial and Alveolar Samples of Bronchoalveolar Lavage Fluid in Asthma

Vyve, T. Van; Chanez, Pascal; Lacoste, Jean-Yves; Bousquet, Jean; Michel, François‐Bernard; Godard, P.

doi:10.1378/chest.102.2.356

Cited by 49 publications

(23 citation statements)

References 31 publications

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“…The first 50 ml sample was defined as the bronchial fraction while subsequent samples were pooled and defined as the alveolar fraction, as previously described (Van Vyve et al 1992). The BAL was filtered through a 100 lm filter and centrifuged at 200Âg for 5 min (þ4 C), and the BAL supernatant was analysed for CC16 as described above.…”

Section: Brush Samples and Bronchoalveolar Lavagementioning

confidence: 99%

Club cell protein (CC16) in plasma, bronchial brushes, BAL and urine following an inhaled allergen challenge in allergic asthmatics

et al. 2017

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Section: Brush Samples and Bronchoalveolar Lavagementioning

confidence: 99%

Club cell protein (CC16) in plasma, bronchial brushes, BAL and urine following an inhaled allergen challenge in allergic asthmatics

et al. 2017

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“…With the latter technique, it is not entirely clear where in the airway the sample originated, but it can shed light on the presence of distal inflammation in asthma. VAN VYVE et al [94] evaluated this technique by naming the first 50 mL aliquot of saline the "bronchial sample" and the subsequent four 50 mL aliquots the "alveolar sample" in control and asthmatic subjects. They noted that the alveolar sample contained significantly more cells than the bronchial sample.…”

Section: Airway Inflammatory Cellsmentioning

confidence: 99%

The distal airways: are they important in asthma?

Kraft¹

1999

Eur Respir J

134

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Although the airways of <2 mm in diameter have been dubbed the "quiet zone", they do not appear to be so in asthma. Physiological and pathological evidence suggests that the small airways and lung parenchyma participate in asthma pathogenesis, and may explain many of the clinical observations noted.This review presents this evidence, beginning with physiological evidence, followed by pathology and last by imaging studies that evaluate the distal lung. Seminal physiological studies date back to the 1960s, with significant progress in the area of airway smooth muscle and its contribution to airways responsiveness noted over the last several years.The use of bronchoscopy in clinical studies has complemented the autopsy studies in advancing knowledge about airway structural changes appreciated in asthma in the small airways and lung parenchyma. These pathological studies have allowed validation of the physiological, and more recently the imaging studies performed to evaluate this compartment of the lung in asthma.Thus, the evidence suggests that the small airways and parenchyma contribute significantly to asthma pathogenesis. The challenge now lies in evaluating this compartment in the context of its value as a therapeutic target in asthma. Eur Respir J 1999; 14: 1403±1417. Data from the last three decades have suggested that the distal lung, which includes the airways of <2 mm and the lung parenchyma, contributes to asthma pathogenesis. Due to the challenges raised in evaluating this part of the lung, this region has not been studied in the same level of detail as have the larger airways. However, a significant amount of pathological data from autopsy specimens and recently from chronic, stable asthmatics, evaluating the small airways and lung parenchyma, are available. These data, combined with physiological data, support a significant role for the distal lung as a contributor to airway inflammation and hyperresponsiveness. The following review will present this evidence and explore the clinically important issue of the distal lung as a therapeutic target in asthma. Physiology of the distal airways Animal and in vitro studiesThe small airways of <2 mm in diameter are pathways of low resistance, and normally contribute~10% of the total resistance to flow. These observations were made in, seminal contributions by MACKLEM and MEAD [1, 2] using a retrograde catheter technique. Using excised dog lobes, they placed a catheter containing bell shaped polyethylene tubing at one end. The bell was wedged into a bronchus with the catheter extending peripherally through the parenchyma and pleura. They showed that the peripheral resistance (Rp) was too small to detect at >80% of vital capacity (VC), but increased at lower volumes to 15% of the total lung resistance at 1% of VC. These data are in keeping with WEIBEL [3], who demonstrated that the cross-sectional area of the small airways was significantly larger than that of the central airways. BROWN et al. [4] further evaluated the effects of small airways occlusion...

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“…The ERS recommends that the first lavage (lavage-1) is used for bacterial culture and any subsequent lavage is used for cytology and non-cellular studies such as immunology-based work (de Blic et al, 2000). Lavage-1 is considered more reflective of bronchial airways, whereas the second (lavage-2) is reflective of distal airways (bronchioles and alveoli), and cellularity results from the two lavages are different (Van Vyve et al, 1992). Thus, it is biologically plausible that cultivable bacteria also differ between lavage-1 and lavage-2.…”

Section: Introductionmentioning

confidence: 99%

Respiratory bacterial culture from two sequential bronchoalveolar lavages of the same lobe in children with chronic cough

Hare

Marsh

Smith‐Vaughan

et al. 2015

Journal of Medical Microbiology

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Identification of bacteria causing lower-airway infections is important to determine appropriate antimicrobial therapy. Flexible bronchoscopy with bronchoalveolar lavage (BAL) is used to obtain lower-airway specimens in young children. The first lavage (lavage-1) is typically used for bacterial culture. However, no studies in children have compared the detection of cultivable bacteria from sequential lavages of the same lobe. BAL fluid was collected from two sequential lavages of the same lobe in 79 children enrolled in our prospective studies of chronic cough. The respiratory bacteria Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and Haemophilus parainfluenzae were isolated and identified using standard published methods. H. influenzae was differentiated from Haemophilus haemolyticus using PCR assays. Lower-airway infection was defined as $10 4 c.f.u. ml 21 BAL fluid. We compared cultivable bacteria from lavage-1 with those from the second lavage (lavage-2) using the k statistic. Lower-airway infections by any pathogen were detected in 46 % of first lavages and 39 % of second lavages. Detection was similar in both lavages for all pathogens; the k statistic was 0.7-0.8 for all bacteria except H. parainfluenzae. Of all infections detected in either lavage, 90 % were detected in lavage-1 and 78 % in lavage-2. However, culture of lavage-2 identified infections that would have been missed in 8 % of children, including infections by additional Streptococcus pneumoniae serotypes. Our findings support the continued use of lavage-1 for bacterial culture; however, culture of lavage-2 may yield additional identifications of bacterial pathogens in lower-airway infections.

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Comparison between Bronchial and Alveolar Samples of Bronchoalveolar Lavage Fluid in Asthma

Cited by 49 publications

References 31 publications

Club cell protein (CC16) in plasma, bronchial brushes, BAL and urine following an inhaled allergen challenge in allergic asthmatics

Club cell protein (CC16) in plasma, bronchial brushes, BAL and urine following an inhaled allergen challenge in allergic asthmatics

The distal airways: are they important in asthma?

Respiratory bacterial culture from two sequential bronchoalveolar lavages of the same lobe in children with chronic cough

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