Use Of Bronchoalveolar Lavage Research Articles

A 2-year Review of the Diagnostic Performance of Serum and Bronchoalveolar Lavage Galactomannan Testing in Lung Transplant Recipients in a National Heart and Lung Transplant Centre.

The 2015 International Society for Heart and Lung Transplant (ISHLT) fungal guidelines recommend the use of bronchoalveolar lavage (BAL) galactomannan over serum galactomannan for the diagnosis of invasive aspergillosis (IA) in lung transplant (LTx) recipients, based on limited evidence. Galactomannan testing is costly. A single-center, retrospective cohort study reviewing all 814 serum and BAL galactomannan samples received from 184 LTx recipients in our center between 2021 and 2022 and assessing their diagnostic performance in the diagnosis of IA. Over the study period, 394 serum galactomannan samples were received from 144 patients and 420 BAL galactomannan samples from 143 patients. Using a cut-off of ≥ 1.0 for BAL galactomannan, the sensitivity and specificity were 65.9% and 98.4%, respectively. In total, 30 patients had positive BAL galactomannan. Antifungal therapy was commenced or continued in 29 of these patients either as targeted or pre-emptive treatment. Using a cut-off of ≥ 0.5 for serum galactomannan, the sensitivity and specificity were 9.7% and 99.7%, respectively. In total, four patients had a positive serum galactomannan. All four patients were either already on antifungal treatment for IA or were started before the serum galactomannan result was available, supported by laboratory, clinical, and radiological findings. A positive serum galactomannan was used to monitor treatment response in one patient. Serum galactomannan is not a valuable test in the diagnosis of IA in our LTx recipients, is costly, and does not remove the need for bronchoscopy and BAL galactomannan. This supports the ISHLT recommendation.

Incidence of Pneumonia following Bronchoscopy and Bronchoalveolar Lavage in Burn Patients.

The standard modality for diagnosis of smoke inhalational injury in burn patients is bronchoscopy with or without bronchoalveolar lavage. However, the risks associated with these procedures are poorly described in established literature. We sought to investigate the association between diagnostic bronchoalveolar lavage at admission and the development of pneumonia in burn patients. This retrospective analysis of intubated burn patients studied those who underwent bronchoscopy on admission, comparing patients who received bronchoalveolar lavage to those who did not. Demographics and baseline characteristics were analyzed using chi-squared or Student's t-test. Unadjusted and multivariable logistic regression studies assessed the effect of admission bronchoalveolar lavage on development of pneumonia. Out of the 196 patients who underwent bronchoscopy, 98 met our criteria for analysis. The bronchoalveolar lavage group was more likely to be male and have a higher grade of abbreviated injury score. Patients who received bronchoalveolar lavage were more likely to develop pneumonia during the admission in both unadjusted and multivariable logistic regression models. These patients also had a longer hospital length of stay, greater number of ventilator days, and were more likely to undergo second bronchoscopy. These findings associate admission bronchoalveolar lavage with increased risk of pneumonia during the index hospitalization, suggesting a judicious use of bronchoalveolar lavage during admission bronchoscopy in burn patients.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Abstract 3862: Identification, profiling and clonotypic tracking of tumor-reactive T cells derived from bronchoalveolar lavage in lung cancer patients

Abstract Immunotherapeutic strategies for disinhibiting T cell responses have revolutionized lung cancer treatment. However, the identification of tumor-reactive T cells and the acquisition of adequate tissue for molecular and immune profiling remains a challenge that hinders our ability to adequately characterize the mechanisms of immunotherapy response versus resistance. To address this gap, we are investigating the use of bronchoalveolar lavage (BAL) as an alternative to blood or tumor biopsy samples to identify tumor reactive T cells. We collected cells from a prospective bronchoscopic biorepository of patients undergoing lung cancer evaluation that were subjected to bilateral BAL, phlebotomy, and tissue sampling. We then employed flow cytometry and single-cell multi-omic analyses to identify, characterize and clonotypically track tumor-reactive T cells obtained from BAL, blood and tumor samples from lung cancer patients. Analysis of BAL samples revealed a significant enrichment of terminally exhausted CD8+CD39+CD103+ T cells in BAL from tumor-bearing lungs compared to non-tumor bearing lung BAL and blood PBMCs in 14 patients. We then used single-cell sequencing-based multi-omics to deeply profile bilateral BAL cells, blood PBMCs and tumor tissues from 5 of these patients. By tracking T cell receptor (TCR) sequences across patient-matched samples, we found BAL derived T cell clonotypes that expressed markers of terminal exhaustion, such as CD39 and CXCL13 in the tumor, which strongly implicates them as being tumor reactive and relatively abundant in BAL. Further validation through functional assays is being used to confirm the tumor reactivity of these clones. These data demonstrate the feasibility of capturing tumor-specific T cells during bronchoscopy, providing promising opportunities for patient outcome characterization and exploration of novel therapies. This relatively non-invasive and practical test during routine bronchoscopy offers a cost-effective and safe alternative to identifying tumor-reactive T cells from surgical specimens or biopsies. Citation Format: Heeju Ryu, Wei Sun, Michelle A. Wurscher, Viswam S. Nair, Evan W. Newell. Identification, profiling and clonotypic tracking of tumor-reactive T cells derived from bronchoalveolar lavage in lung cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3862.

Substantiation of the possibility of using bronchoalveolar lavage with perfluorocarbon fluids for the treatment of the alveolar stage of toxic pulmonary edema

Introduction. Toxic pulmonary edema is an acute syndrome characterized by the accumulation of fluid in the extravascular spaces of the lungs, impaired gas exchange, the formation of tissue hypoxia and acidosis, which can occur in acute inhalation poisoning with pulmonary toxicants at work. Existing methods of drug and respiratory therapy are ineffective in the development of alveolar pulmonary edema (end-stage acute respiratory distress syndrome; ARDS). In this regard, the search for new approaches to the treatment of this condition, which is characterized by almost 100 % mortality, is of great practical importance. One of such approaches is the use of perfluorocarbon (PFC) fluids, which, due to their unique physical and chemical properties, are able not only to ensure the evacuation of edematous fluid from the alveoli and respiratory tract, but also to restore gas exchange in the parts of the lungs filled with them. This article will present an experimental evaluation of the use of PFC fluids in a model of the alveolar stage of toxic pulmonary edema.
 The goal of the study is to determine the effect of bronchoalveolar lavage (BAL) using perfluorocarbons on the indicators of acute respiratory failure and the outcome of the alveolar stage of toxic pulmonary edema.
 Materials and methods. The study was carried out on male Wistar rats aged 4 months, weighing 180–230 g. Toxic pulmonary edema was initiated by endotracheal injection of 0.1 M HCl solution. Anesthetized rats were intubated with a cannula, then intratracheally injected with 0.1 M HCl solution at a dose of 2 ml/kg and connected to a ventilator. After that, the animals were randomized by weight into groups of 6 individuals each. Animals of the experimental group with a decrease in saturation below 80%, 2–6 procedures of bronchoalveolar lavage (BAL) with PFC-oxygenated liquid in a single dose of 2.0 ml/kg were performed. Heart rate, oxygen saturation, duration of survival, and overall survival by group were recorded.
 The resalts. In all rats, there was a decrease in oxygen saturation (SpO2) and heart rate (HR) after HCl administration, which was restored to the lower limits of normal within 5 minutes. However, after 25 to 30 minutes, the animals experienced a rapid decrease in SpO2, an increase in heart rate, the appearance of wet wheezing in the lungs, and the discharge of foamy fluid from the catheter. Against this background, there was a rapid death of animals, At the same time, the average duration of survival was 30.6±3.3 min. In turn, in the animals of the experimental group, after each BAL procedure, an increase in saturation was noted, it was possible to evacuate a total of 9.1±0.8 ml/kg of edematous fluid from the lungs. It was also noted that the average duration of survival of rats in the experimental group was 1.69 times and amounted to 51.6±3.8 minutes.
 Conclusions. The use of BAL with PFC fluids in the alveolar stage of toxic pulmonary edema makes it possible to evacuate a significant amount of edematous fluid from the lower parts of the lungs due to its displacement by a perfluorocarbon with a higher density; to short-term reduce the severity of manifestations of acute respiratory failure after instillation of oxygenated PFC liquid; to increase the duration of survival of animals by ensuring gas exchange in previously uninvolved parts of the lungs.
 Ethics. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The Clinical Study Protocol was reviewed at a meeting of the local Ethics Committee FSBSI IRIOH. Protocol No. 4 of May 25, 2022.

ЛЕГЕНЕВИЙ АЛЬВЕОЛЯРНИЙ ПРОТЕЇНОЗ: ВИПАДОК СУБТОТАЛЬНОГО УРАЖЕННЯ ПАРЕНХІМИ ЛЕГЕНЬ)

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease, characterized by the intraalveolar accumulation of surfactant-like lipoprotein substance. There are three forms of the disease: autoimmune (formerly known as idiopathic), secondary and congenital PAP. The disturbances of surfactant metabolism (protein-lipoid complex secreted by type II pneumocytes) play the crucial role in the development of the disease. Surfactant decreases a surface tension of alveoli and prevents its collapse at the end of the expiration and takes part in protection against infections as well. Surfactant is inactivated through the transformation into the surface-inactive aggregates, which are mainly absorbed by type II pneumocytes. The rest of surfactant are catabolized by alveolar macrophages (AM). This process is regulated by cytokines, especially granulocyte-macrophage colony-stimulating factor (GM-CSF) being the most important of them. Disturbances of interrelation between GM-CSF and cellular receptors blocks the signals to effector cells for surfactant deactivation. This is resulted in excessive accumulation of surfactant in alveoli. General lavage of the lung is a standard method of symptomatic management of PAP. Contemporary pathogenesis treatment uses two approaches — increasing the clearance of surfactant by means of exogenous GM-CSF administration and decreasing the level of GM-CSF antibodies using the rituximab and plasmapheresis. Due to the use of broncho-alveolar lavage (BAL) 5-year survival rate of th patients reaches 95 %. The mortality depends on the area of lung lesion and reversely correlated with the timely diagnosis and treatment. We report the case of subtotal lung parenchyma lesion associated with severe respiratory failure in 46 years old patient. Three series of BAL (5 procedures in each with 1-2 months interval) were performed using the limited volume of lavage fluid due to the severity of the patient’s condition. The results was an improvement of clinical condition, resolution of respiratory failure, significant reduction of the size of the lesions, improved lung transparency on CT scan, restoration of lung diffusion and total lung capacity. Conclusion. Therapeutic BAL is an effective method of PAP management. The outcome of clinical case presented and our many years experience confirm not only the effectiveness of conventional BAL with reduced lavage volume application but also a safety of fiberoptic bronchoscopy, especially in patients with subtotal involvement of lung parenchyma. Key words: pulmonary alveolar proteinosis, subtotal pulmonary parenchyma involvement, pulmonary bronchoalveolar lavage, efficiency.

The Role of Bronchoalveolar Lavage in Systemic Sclerosis Interstitial Lung Disease: A Systematic Literature Review.

The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than in the health control and, in some cases, they were related to more severe pulmonary disease. There was no consensus regarding the role of BAL cellularity as a predictor of mortality.

UTILITY OF BAL FOR EVALUATION OF PULMONARY INFECTIONS IN PATIENTS WITH AUTOIMMUNE DISEASE: A SINGLE CENTER ANALYSIS

UTILITY OF BAL FOR EVALUATION OF PULMONARY INFECTIONS IN PATIENTS WITH AUTOIMMUNE DISEASE: A SINGLE CENTER ANALYSIS

DNA Methylation Profiles of Purified Cell Types in Bronchoalveolar Lavage: Applications for Mixed Cell Paediatric Pulmonary Studies

In epigenome-wide association studies analysing DNA methylation from samples containing multiple cell types, it is essential to adjust the analysis for cell type composition. One well established strategy for achieving this is reference-based cell type deconvolution, which relies on knowledge of the DNA methylation profiles of purified constituent cell types. These are then used to estimate the cell type proportions of each sample, which can then be incorporated to adjust the association analysis. Bronchoalveolar lavage is commonly used to sample the lung in clinical practice and contains a mixture of different cell types that can vary in proportion across samples, affecting the overall methylation profile. A current barrier to the use of bronchoalveolar lavage in DNA methylation-based research is the lack of reference DNA methylation profiles for each of the constituent cell types, thus making reference-based cell composition estimation difficult. Herein, we use bronchoalveolar lavage samples collected from children with cystic fibrosis to define DNA methylation profiles for the four most common and clinically relevant cell types: alveolar macrophages, granulocytes, lymphocytes and alveolar epithelial cells. We then demonstrate the use of these methylation profiles in conjunction with an established reference-based methylation deconvolution method to estimate the cell type composition of two different tissue types; a publicly available dataset derived from artificial blood-based cell mixtures and further bronchoalveolar lavage samples. The reference DNA methylation profiles developed in this work can be used for future reference-based cell type composition estimation of bronchoalveolar lavage. This will facilitate the use of this tissue in studies examining the role of DNA methylation in lung health and disease.

Transbronchial biopsy vs. bronchoalveolar lavage in interstitial lung disease.

Interstitial lung diseases (ILDs) are heterogeneous disorders characterized by varying degrees of inflammation and fibrosis in the lung parenchyma. The use of bronchoalveolar lavage (BAL) cellular analysis and transbronchial biopsy with forceps (TBLB) in ILD is often a matter of debate. ILDs have been a diagnostic challenge and require multidisciplinary discussion (MDD) to develop a consensus diagnosis based on clinical, radiologic, laboratory, BAL cellular analysis, and histologic information. The BAL cellular analysis is a commonly performed tool, and some ILDs have distinctive cellular findings. Its use alone is seldom diagnostic and almost always requires clinical, radiologic findings, and or histologic information interpretation. The minimally invasive procedures, such as TBLB, transbronchial cryo-biopsy (TBCB), and invasive procedures, such as surgical lung biopsy (SLB) help obtain a histologic diagnosis. This review serves as a resource to assist clinicians to develop effective communication and close collaboration through MDD for accurate selection of diagnostic tools to reach the correct and final diagnosis.

Role of bronchoalveolar lavage in the management of immunocompromised patients with pulmonary infiltrates.

Pulmonary infiltrates are a significant cause of morbidity and mortality in immunocompromised patients and remain a diagnostic challenge due to the broad range of etiologies that include infection and malignancy. Empiric therapy may be sub-optimal and can adversely impact outcome. Therefore, a confirmed diagnosis is necessary and flexible bronchoscopy with bronchoalveolar lavage (BAL) may be a useful diagnostic tool. Samples are obtained for microbiological and cytological testing, but the procedure carries risk of complications including the adverse events related to moderate sedation. A review of published literature on BAL in immunocompromised patients from the year 2000 was undertaken focusing on diagnostic yield, complication rate, mortality as well as factors impacting these outcomes. Studies in which the majority of patients were supported on mechanical ventilation were excluded. A total of 23 studies (7 prospective and 16 retrospective) met inclusion criteria. This covered 3,395 procedures in 3,192 patients with a mean age of 47.4 years; 60.3% male gender. Diagnostic yield ranged from 26% to 69% with no clear association between diagnostic yield and etiology of immunosuppression or clinical/radiological presentation. Post BAL modification of treatment as an indicator for clinical utility ranged from 11% to 84%; and complication rate ranged from 1% to 52%. No specific factors were associated with increased adverse event rate. This review provides a summary of the data on the use of BAL for diagnosis of pulmonary infiltrates in immunocompromised patients, highlighting the heterogeneity of patients, significant variation in findings reported and the need for more data to optimize patient selection.

Neonatal bronchoscopy: Role in respiratory disease of the newborn-A 7 year experience.

Bronchoalveolar lavage (BAL) is a standardized method to obtain specimen samples from the airway lumen of the respiratory system. BAL is used to diagnose lung infection and infection markers in neonates. The aim was to evaluate the utility of flexible fiberoptic bronchoscopy in term and preterm neonates and to evaluate the use of BAL obtained by bronchoscopy in neonatal lung disease. A retrospective analysis of Neonatal Intensive Care Unit (NICU) babies, during a 7-year period was conducted on 599 neonates who underwent the BAL procedure. Characteristics of the patients, indications, complications, and results of the procedure were recorded. The main indications were nosocomial pneumonia (140) and unilateral lung disease (74). A normal finding was most prevalent (201), followed by tracheitis (65). Microbiology on BAL fluid was positive in 33% of bronchoscopies (195/599); most common organisms isolated were Acinetobacter, Klebsiella, and Pseudomonas. Neonatal bronchoscopy can serve as an important diagnostic and therapeutic tool in the management of neonatal lung disease, BAL specimen microbiology from bronchoscopy directs clinical decision making in the management of neonatal lung infection. Individual common markers of infection have poor correlation to BAL. A combination of the markers, however, improves correlation with BAL but their utility in clinical management of lung infection is subject to caution. A negative BAL may shift management emphasis on minimizing lung injury especially in neonates who are ventilator dependent; BAL has the potential to critically affect the management of babies with significant lung disease especially when ventilator dependent.

Differential detection of tuberculous and non-tuberculous mycobacteria by qPCR in lavage fluids of tuberculosis-suspicious white rhinoceros.

Tuberculosis (TB) occurs in a wide range of mammalian species and thus poses a health risk to humans living or working in close proximity with TB infected animals. Despite a high incidence of M. bovis infections in domestic or wildlife species tuberculosis infections in rhinoceros have so far been very limited. Over the past 53 years, tuberculosis of the respiratory tract has been confirmed in just 22 rhinoceros, most of those infected not by M. bovis but M. tuberculosis. However, because of the zoonotic risk TB testing is recommended or becomes even mandatory in endangered species. The dilemma in rhinoceros and many other wildlife species; non-validated tests are highly inconsistent in their ability to identify TB infection. Current lack of TB diagnostics may result in TB positive rhinoceros living with the infection, transmitting it to those around them or in euthanasia of animals found unconfirmed at necropsy. This is an unacceptable diagnostic status considering that some species are critically endangered and therefore should not be euthanized in order to confirm suspicion of disease. To overcome this shortcoming we used bronchoscopy to detect mycobacteria in respiratory fluids of TB suspicious rhinoceros. Fluids from seven, TB suspicious white rhinoceros were harvested during 21 bronchoscopies. Our new approach: In addition to bacterial culture a dual quantitative PCR system tested for the general presence of DNA from NTM and more specifically for DNA from MTC. Both, bacterial culture and qPCR were negative for MTC in respiratory fluids of all rhinoceros (7/7). At the same time, respiratory fluids from six rhinoceros tested positive for the presence of NTM or other closely related bacteria (6/7). M. tuberculosis was found only once in an oesophageal aspirate. The high incidence of mycobacterial DNA in the respiratory tract suggests that white rhinoceros, as strict grazers, are immensely exposed to environmental bacteria of this genus. Presence of NTM in the respiratory or intestinal system could possibly cause false positive results in intradermal tests. A wider use of bronchoalveolar lavage is warranted to further elucidate immunologic response to NTM and exposure to, incidence and prevalence of MTC infections in rhinoceros.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Early diagnosis and treatment of lower respiratory tract infections are the mainstay of management of lung disease in cystic fibrosis. When sputum samples are unavailable, treatment relies mainly on cultures from oropharyngeal specimens; however, there are concerns regarding the sensitivity of these to identify lower respiratory organisms.Bronchoscopy and related procedures (including bronchoalveolar lavage) though invasive, allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may help in a more accurate diagnosis of lower respiratory tract infections and guide the selection of antimicrobials, which may lead to clinical benefits.This is an update of a previous review. To evaluate the use of bronchoscopy-guided antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 30 August 2018.We also searched three registries of ongoing studies and the reference lists of relevant articles and reviews. Date of latest search: 10 April 2018. We included randomized controlled studies including people of any age with cystic fibrosis, comparing outcomes following therapies guided by the results of bronchoscopy (and related procedures) with outcomes following therapies guided by the results of any other type of sampling (including cultures from sputum, throat swab and cough swab). Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information. The quality of the evidence was assessed using the GRADE criteria. The search identified 11 studies, but we only included one study enrolling infants with cystic fibrosis under six months of age and diagnosed through newborn screening (170 enrolled); participants were followed until they were five years old (data from 157 children). The study compared outcomes following therapy directed by bronchoalveolar lavage for pulmonary exacerbations with standard treatment based on clinical features and oropharyngeal cultures.We considered this study to have a low risk of bias; however, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was limited due to the prevalence (of Pseudomonas aeruginosa isolation in bronchoalveolar lavage samples at five years age) being much lower in both the groups compared to that which was expected and which was used for the power calculation. The sample size was adequate to detect a difference in high-resolution computed tomography scoring. The quality of evidence for the key parameters was graded as low except high-resolution computed tomography scoring and cost of care analysis, which were graded as moderate quality.At five years of age, there was no clear benefit of bronchoalveolar lavage-directed therapy on lung function z scores or nutritional parameters. Evaluation of total and component high-resolution computed tomography scores showed no significant difference in evidence of structural lung disease in the two groups.In addition, this study did not show any difference between the number of isolates of Pseudomonas aeruginosa per child per year diagnosed in the bronchoalveolar lavage-directed therapy group compared to the standard therapy group. The eradication rate following one or two courses of eradication treatment was comparable in the two groups, as were the number of pulmonary exacerbations. However, the number of hospitalizations was significantly higher in the bronchoalveolar lavage-directed therapy group, but the mean duration of hospitalizations was significantly less compared to the standard therapy group.Mild adverse events were reported in a proportion of participants, but these were generally well-tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of bronchoalveolar lavage in 4.8% of procedures. This review, limited to a single, well-designed randomized controlled study, shows no clear evidence to support the routine use of bronchoalveolar lavage for the diagnosis and management of pulmonary infection in pre-school children with cystic fibrosis compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence was available for adult and adolescent populations.

The utility of bronchoalveolar lavage in the evaluation of interstitial lung diseases: A clinicopathological perspective.

Bronchoalveolar lavage (BAL) is a noninvasive and well-tolerated procedure that is performed with a fiberoptic bronchoscope in the wedged position within a selected bronchopulmonary segment. After it was introduced to clinical practice, BAL rapidly gained acceptance in a large number of centers as a procedure that could be applied to the clinical evaluation of patients with various pulmonary disorders, especially the group of interstitial lung diseases (ILD). Cytological and flow cytometric analysis of BAL fluid in ILD is done with knowledge of the clinical presentation and radiological findings. BAL typically reveals variations in the types and numbers of nucleated immune cells and acellular components in patients with ILD, which differ from those seen in normal control subjects. Many clinicians currently use this technique as a guide in the differential diagnoses of ILD; it can also be used to monitor the course of disease and possible response to therapeutic interventions. This article summarizes current clinicopathological information concerning the use of BAL by pulmonologists and pathologists.

Histologic investigation of airway inflammation in postmortem lung samples from racehorses.

OBJECTIVE To describe histologic findings in the small airways during postmortem examination of actively racing horses and to quantify the degree of airway inflammation by use of a semiquantitative scoring system. SAMPLE Lung tissues obtained from 95 horses (Thoroughbreds, Standardbreds, and Quarter Horses) that had been actively racing or training. PROCEDURES 10 standardized lung sections were obtained during postmortem examination of 37 horses that had been actively racing or training, and 2 histologic sections of the caudodorsal lung lobes previously collected from each of 58 horses that died or were euthanized during racing or training were also obtained. Sections were evaluated by use of a validated histologic small airway scoring system. RESULTS Scores for inflammatory cells, smooth muscle, and hemosiderin typically were high. Signalment and cause of death were not significant predictors of lung scores. Lung sample location was a significant predictor, with the highest scores in the caudal and dorsal sections. Inflammatory cell infiltration in peribronchiolar tissues, smooth muscle hyperplasia, and hemosiderin (prevalence of 86%, 98%, and 80%, respectively) were common findings in lungs of these horses, with the caudodorsal regions more severely affected. Correlation was moderate between smooth muscle hyperplasia and inflammatory cell infltration, with minimal correlation between hemosiderin and inflammatory cell infiltration. CONCLUSIONS AND CLINICAL RELEVANCE Inflammatory airway disease has been identified by use of bronchoalveolar lavage in young athletic horses throughout the world. In the study reported here, pathological changes were detected in the wall of small airways of horses that were actively training or racing.

Evaluation of oxidative stress in caprine bronchoalveolar lavage fluid of pneumonic and normal lungs

Research in the area of oxidative stress in pneumonic pathology still requires attention in small ruminants especially with the use of bronchoalveolar lavage (BAL) which may be a more sensitive indicator of respiratory diseases than blood. This investigation evaluates the role of oxidative stressin the pathogenesis of caprine pneumonia using BAL fluid (BALf) from healthy and pneumonic goats. A BALf from 192 goats (whose pneumonic histopathology had been characterized using standard techniques) was biochemically assayed for anti-oxidants and pro-oxidants. Malondialdehyde (MDA), hydrogen peroxide generation (H2O2), myeloperoxidase (MPO) and reduced glutathione (GSH) contents were measured to assess free radical activity in the BALf. Superoxide dismutase (SOD), Glutathione transferase (GST) and Glutathione peroxidase (GPx) activity were also determined colourimetrically. There were significant increases in the BALf supernatant of MDA, H2O2 and MPO with decreases in GSH level and SOD activity in the pneumonic goats (P<0.05). There was also significant correlation of BALf oxidative assay to the type and severity of pneumonia. The levels of MDA, H2O2, and MPO increased significantly (P<0.05) in bronchopneumonia and bronchointerstitial pneumonia than other pneumonic conditions and normal lungs. The management of caprine pneumonia should often incorporate antioxidant supplementation to correct the imbalance in pro-oxidant and anti-oxidant levels.

Single-aliquot, non-bronchoscopic bronchoalveolar lavage in the diagnosis of metastatic mammary tumours in dogs.

To evaluate the use of bronchoalveolar lavage as an auxiliary tool for the diagnosis of neoplastic lung metastasis from mammary tumours in dogs. A single-institution prospective observational study including 20 healthy dogs and 30 with mammary tumours. Thoracic radiography and single-aliquot, non-bronchoscopic bronchoalveolar lavage with cytology interpretation was performed in all animals and the results compared between groups. Dogs with mammary gland tumours and radiographic evidence of pulmonary metastasis had significantly higher relative neutrophil counts in bronchoalveolar lavage fluid than dogs with tumours without evidence of metastasis. In only one dog, in which thoracic radiographs were normal, were malignant cells identified in bronchoalveolar lavage fluid. Inflammatory bronchoalveolar lavage fluid in dogs with mammary gland tumours may suggest metastatic disease. Bronchoalveolar lavage does not appear to be sensitive for identifying malignant cells.

Bronchoalveolar lavage: perspective from the 11th BAL Conference

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Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Early diagnosis and treatment of lower respiratory tract infections are the mainstay of management of lung disease in cystic fibrosis. When sputum samples are unavailable, treatment relies mainly on cultures from oropharyngeal specimens; however, there are concerns regarding the sensitivity of these to identify lower respiratory organisms.Bronchoscopy and related procedures (including bronchoalveolar lavage) though invasive, allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may help in a more accurate diagnosis of lower respiratory tract infections and guide the selection of antimicrobials, which may lead to clinical benefits.This is an update of a previous review. To evaluate the use of bronchoscopy-guided antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched two registries of ongoing studies and the reference lists of relevant articles and reviews.Date of latest search: 28 August 2015. We included randomized controlled studies including people of any age with cystic fibrosis, comparing outcomes following therapies guided by the results of bronchoscopy (and related procedures) with outcomes following therapies guided by the results of any other type of sampling (including cultures from sputum, throat swab and cough swab). Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information. The search identified nine studies, but only one study with data from 157 participants (170 people were enrolled) was eligible for inclusion in the review. This study compared outcomes following therapy directed by bronchoalveolar lavage for pulmonary exacerbations during the first five years of life with standard treatment based on clinical features and oropharyngeal cultures. The study enrolled infants with CF who were under six months of age and diagnosed through newborn screening and followed them until they were five years old.We considered this study to have a low risk of bias; however, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was limited due to the prevalence (of Pseudomonas aeruginosa isolation in bronchoalveolar lavage samples at five years age) being much lower in both the groups compared to that which was expected and which was used for the power calculation. The sample size was adequate to detect a difference in high-resolution computed tomography scoring. The quality of evidence for the key parameters was graded as moderate except high-resolution computed tomography scoring and cost of care analysis, which were graded as high quality.At five years of age, there was no clear benefit of bronchoalveolar lavage-directed therapy on lung function z scores or nutritional parameters. Evaluation of total and component high-resolution computed tomography scores showed no significant difference in evidence of structural lung disease in the two groups.In addition, this study did not show any difference between the number of isolates of Pseudomonas aeruginosa per child per year diagnosed in the bronchoalveolar lavage-directed therapy group compared to the standard therapy group. The eradication rate following one or two courses of eradication treatment was comparable in the two groups, as were the number of pulmonary exacerbations. However, the number of hospitalizations was significantly higher in the bronchoalveolar lavage-directed therapy group, but the mean duration of hospitalizations was significantly less compared to the standard therapy group.Mild adverse events were reported in a proportion of participants, but these were generally well-tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of bronchoalveolar lavage in 4.8% of procedures. This review, limited to a single, well designed randomized-controlled study, shows no clear evidence to support the routine use of bronchoalveolar lavage for the diagnosis and management of pulmonary infection in pre-school children with cystic fibrosis compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence was available for adult and adolescent populations.