Investigations of broncho-alveolar lavage in children with asthma, bronchiectasis and cystic fibrosis

Abstract

Aim: The purpose of this work is to evaluate the clinical significance of bronchoalveolar lavage (BAL) in children with asthma (A), bronchiectasis (BE) and cystic fibrosis (CF) Methods: For period of 2006-2009 we performed bronchoscopy with obtaining broncho-alveolar lavage of 60 children aged 4 to 17 years, divided in three groups: Group I - BE(10 children); Group II – A (20children); Group III – CF (30 children). All children underwent a fibrobronchoscopy with BALaspiration. Microbilogical, cytological and immunological examinations of the BAL liquid were performed. Results: Eosinophils were typical for group II. Neutrophil-dominated endobronchial inflammation was characteristic for CF and BE groups. For CF the levels of polymorphonuclear cells were 30-79%. BE children with catarrhal endobronchitis had high level of SIgA and IgG; CF children with purulent endobonchitis, had IgG levels even higher with demonstrative low levels SIgA; for children with A we found low level of SIgA and high level of IgE. As a contrast of the other groups all CF patients had significantly low levels of a 1 -antitripsin. Most common microbiology finding in CF patients was P.aeruginosa , followed by S.aureus . The patients with A didn9t have any clinical relevant pathogen, while for BE a diverse microbial flora, without any prevalent pathogen was found. Conclusions: If used properly, BAL can be a useful clinical tool that can assist in the diagnosis and follow up in children with A, BE and CF, for it reflects the extent of the chronic inflammation and chronic infection in the lungs.