Advertisement

Bronchoalveolar Lavage

  • Franz Stanzel
Chapter

Abstract

Bronchoalveolar lavage (BAL) is a minimally invasive procedure and plays an important role in the diagnostic evaluation of interstitial lung disease, pulmonary infiltrates, and some infectious diseases. The decision to perform bronchoscopy and BAL should be guided by clinical presentation and the patient’s status as well as local technical expertise, both in performing the procedure and in interpreting the results. An important problem with interpreting BAL results is the variability between centers, which highlights the importance of following standard protocols. There is a need for a consensus statement among experts to provide guidelines for the utility of BAL cellular analyses in clinical practice. A number of specific conditions, such as some rare diseases, malignancy, and infections, can be diagnosed by BAL analyses. In such cases, more invasive procedures can be avoided. Even when nondiagnostic, BAL cellular analysis usually adds valuable information to the clinical and radiological data and helps to narrow the differential diagnosis. On the other hand, the diagnostic usefulness of BAL in interstitial lung disease, especially idiopathic pulmonary fibrosis (IPF), is limited. An important issue of BAL in this setting is exclusion of other diseases as sarcoidosis or hypersensitivity pneumonitis. BAL is an invaluable research tool for ILD, providing information regarding immune effector cells that accumulate in the alveoli and their noncellular products. With the increasing availability of proteomics, the importance of biomarkers of ILD will hopefully become clear in the near future. It is essential that BAL findings be interpreted by experts in the context of clinical and radiological data.

Keywords

Idiopathic Pulmonary Fibrosis Interstitial Lung Disease Hypersensitivity Pneumonitis Usual Interstitial Pneumonia Idiopathic Pulmonary Fibrosis Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Allen JN, Davis WB. Eosinophilic lung diseases. Am J Respir Crit Care Med. 1994;150:1423–38.PubMedCrossRefGoogle Scholar
  2. 2.
    American Thoracic Society/European Respiratory Society. ATS/ERS international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2002;165:277–304.CrossRefGoogle Scholar
  3. 3.
    Baughman RP, Raghu G. Bronchoalveolar cellular analysis in scleroderma lung disease: does Sutton’s law hold? Am J Respir Med. 2008;177:2–3.CrossRefGoogle Scholar
  4. 4.
    Bonella F, Ohshimo S, Bauer P, Guzman J, Costabel U. Bronchoalveolar lavage. In: Strausz J, Bolliger CT, editors. Interventional pulmonology. Eur Respir Monogr. 2010;48: 59–72.Google Scholar
  5. 5.
    Costabel U, editor. Atlas der bronchoalveolären Lavage. Stuttgart: Thieme; 1994.Google Scholar
  6. 6.
    Costabel U, Guzman J, Bonella F, Oshimo S. Bronchoalveolar lavage in other interstitial lung diseases. Semin Respir Crit Care Med. 2007;28:514–24.PubMedCrossRefGoogle Scholar
  7. 7.
    Costabel U. CD4:CD8 ratios in bronchoalveolar lavage fluid: of value for diagnosing sarcoidosis? Eur Respir J. 1997;10:2699–700.PubMedCrossRefGoogle Scholar
  8. 8.
    Drent M, Baughman RP, Meyer KC. Bronchoalveolar lavage. In: Costabel U, du Bois RM, Egan JJ, editors. Diffuse parenchymal lung disease. Prog Respir Res. 2007;36:58–67.Google Scholar
  9. 9.
    Drent M, Mansour K, Linssen C. Bronchoalveolar lavage in sarcoidosis. Semin Respir Crit Care Med. 2007;28:486–95.PubMedCrossRefGoogle Scholar
  10. 10.
    Flaherty KR, King TE, Raghu G, Lynch JP, Colby TV, Travis WD, Gross BH, Kazerooni EA, Toews GB, Long Q, Murray S, Lama VN, Gay SE, Martinez FJ. Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? Am J Respir Crit Care Med. 2004;170:904–10.PubMedCrossRefGoogle Scholar
  11. 11.
    Haslam PL, Baughman RP. Report of ERS Task Force: guidelines for measurement of acellular components and standardization of BAL. Eur Respir J. 1999;14:245–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Höffken G, Lorenz J, Kern W, Welte T, Bauer T, Dalhoff K, Dietrich E, Ewig S, Gastmeier P, Grabein B, Halle E, Kolditz M, Marre R, Sitter H. Guidelines of the Paul-Ehrlich-Society of Chemotherapy, the German Respiratory Diseases Society, the German Infectious Diseases Society and of the Competence Network CAPNETZ for the management of lower respiratory tract infections and community-acquired pneumonia summary of the update 2009. Pneumologie. 2010;64:149–54.PubMedCrossRefGoogle Scholar
  13. 13.
    Kinder BW, Brown KK, Schwarz MI, Ix JH, Kevitsky A, King TE. Baseline BAL neutrophilia predicts early mortality in idiopathic pulmonary fibrosis. Chest. 2008;133:226–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Klech H, Hutter C. Clinical guidelines and indications for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Force on BAL. Eur Respir J. 1990;3:937–74.Google Scholar
  15. 15.
    Klech H, Pohl W. Technical recommendations and guidelines for bronchoalveolar lavage (BAL). Report of the European Society of Pneumology Task Group. Eur Respir J. 1989;2:561–85.Google Scholar
  16. 16.
    Meyer KC. The role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med. 2004;25:637–49.PubMedCrossRefGoogle Scholar
  17. 17.
    Ohshimo S, Bonella F, Cui A, Beume M, Kohno N, Guzman J, Costabel U. Significance of bronchoalveolar lavage for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2009;179:1043–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Ryu YJ, Chung MP, Han J, Kim TS, Lee KS, Chun EM, Kyung SY, Jeong SH, Colby TV, Kim H, Kwon OJ. Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias. Respir Med. 2007;101:655–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Spagnolo P, Luppi F, Rossi G, Richeldi L. To BAL or not to BAL: is this a problem in diagnosing IPF? Am J Respir Crit Care Med. 2009;180:379–80.PubMedCrossRefGoogle Scholar
  20. 20.
    Spagnolo P, Richeldi L, Raghu G. The role of bronchoalveolar lavage cellular analysis in the diagnosis of interstitial lung diseases. Eur Respir Monogr. 2009;46:36–46.Google Scholar
  21. 21.
    Tazi A. Adult pulmonary Langerhans’ cell histiocytosis. Eur Respir J. 2006;27:1272–85.PubMedCrossRefGoogle Scholar
  22. 22.
    The BAL Cooperative Group Steering Committee. Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups. Am Rev Respir Dis. 1990;141:S169–202.CrossRefGoogle Scholar
  23. 23.
    Travis WD, Hunninghake G, King TE, Lynch DA, Colby TV, Galvin JR, Brown KK, Chung MP, Cordier JF, du Bois RM, Flaherty KR, Franks TJ, Hansell DM, Hartman TE, Kazerooni EA, Kim DS, Kitaichi M, Koyama T, Martinez FJ, Nagai S, Midthun DE, Müller NL, Nicholson AG, Raghu G, Selman M, Wells A. Idiopathic nonspecific interstitial pneumonia: report of an American Thoracic Society project. Am J Respir Crit Care Med. 2008;177:1338–47.PubMedCrossRefGoogle Scholar
  24. 24.
    Wells AU. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med. 2001;22:449–50.PubMedCrossRefGoogle Scholar
  25. 25.
    Wells AU. The clinical utility of bronchoalveolar lavage in diffuse parenchymal lung disease. Eur Respir Rev. 2010;19:237–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Ye Q, Nakamura S, Sarria R, Costabel U, Guzman J. Interleukin 12, interleukin 18, and tumor necrosis factor alpha release by alveolar macrophages: acute and chronic hypersensitivity pneumonitis. Ann Allergy Asthma Immunol. 2009;102:149–54.PubMedCrossRefGoogle Scholar
  27. 27.
    Ziegenhagen MW, Rothe ME, Schlaak M, Müller-Quernheim J. Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis. Eur Respir J. 2003;21:407–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Franz Stanzel
    • 1
  1. 1.Department of PneumologyLung Clinic HemerHemerGermany

Personalised recommendations