Source: Annual Congress 2001 - Interstitial lung disease: BAL in diagnosis and management
Disease area: Interstitial lung diseases

Abstract

Recently, the classification of idiopathic interstitial pneumonia has changed, and idiopathic pulmonary fibrosis (IPF) is now more narrowly defined and limited to the histopathology of usual interstitial pneumonia (UIP). Several entities with a better prognosis have been removed from the diagnosis of IPF. Little is known about possible differences in BAL cell differentials between these subgroups.
In this study histologcial specimen obtained by surgical lung biopsy during a 7 year period were re-analyzed according to the new histopathological classification. 81 patients with idiopathic interstitial pneumonia were identified, in 53 of them BAL analysis was available. BAL had been performed by standard procedure, usually with 5 x 20 ml aliquots of saline.
The results are shown in the table. In UIP, neutrophils and eosinophils were elevated. A similar profile emerged in desquamative interstitial pneumonia/respiratory bronchiolitis with interstitial lung disease (DIP/RBILD). In contrast, patients with non-specific interstitial pneumonia (NSIP) had markedly elevated percentages of lymphocytes. The highest lymphocyte count was seen in bronchiolitis obliterans organizing pneumonia (BOOP).

BAL cells	UIP	DIP/RBILD	NSIP	BOOP
	n=22	n=8	n=14	n=9
Macrophages	66±]19	76±]20	49±]31	44±]35
Lymphocytes	19±]14	14±]19	34±]29	41±]36
Neutrophils	9±]6	7±]9	12±]14	8±]15
Eosinophils	5±]12	5±]7	5±]7	5±]12
Mast Cells	0.5±]0.4	0.1±]0.2	0.4±]0.5	0.3±]0.4

Data are % of total cells in BAL fluids, ±]SD
The results of this study are in agreement with the data from Nagai et al (1999). We conclude that a marked increase in lymphocytes is rather associated with NSIP and BOOP, two entities with a better prognosis than UIP.

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Citations should be made in the following way:
H. M. Mueller, D. Theegarten, U. Costabel (Bochum, Essen, Germany). BAL cell differentials in the newly defined subgroups of idiopathic interstitial pneumonia. Eur Respir J 2001; 16: Suppl. 31, 3415

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