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. 1980 May;35(5):328–339. doi: 10.1136/thx.35.5.328

Bronchoalveolar lavage fluid cell counts in cryptogenic fibrosing alveolitis and their relation to therapy.

P L Haslam, C W Turton, A Lukoszek, A J Salsbury, A Dewar, J V Collins, M Turner-Warwick
PMCID: PMC471286  PMID: 7434282

Abstract

Bronchoalveolar lavage was used to sample inflammatory cells from the lungs of 51 patients with cryptogenic fibrosing alveolitis (CFA) (24 smokers, 12 ex-smokers, and 15 non-smokers). The smokers with CFA have been compared with 15 smoking control subjects in whom there was no radiographic abnormality or clinical evidence of chronic bronchitis. Significantly lower volumes of lavage fluid were recovered from the smokers with CFA (p < 0.001) and the fluid contained lower percentages of macrophages (p < 0.01), reflecting increased percentages of eosinophils (p < 0.001) and neutrophils (p < 0.01). Similar changes were seen in the ex-smokers and non-smokers. There was also an increase in the percentages of lymphocytes when the whole group of CFA patients was compared with the control subjects (p less than or equal to 0.05). No significant differences were found when patients with "lone" CFA were compared with those having associated systemic disease. The only feature distinguishing smokers from non-smokers with CFA was the presence of pigmented cytoplasmic inclusions in the macrophages from the smokers (p < 0.001). However, there were lower numbers of pigmented macrophages in the smoking CFA patients by comparison with the control subjects suggesting either a change in phagocytic capacity or turnover rate in this disease. Profiles of differential cell counts in individual patients showed that increases of eosinophils over 3% or neutrophils over 4% or both with lymphocyte counts of less than 11% related to a poor clinical response to corticosteroids, but lymphocyte percentages greater than 11% related to improvement (p < 0.05).

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brody A. R., Craighead J. E. Cytoplasmic inclusions in pulmonary macrophages of cigarette smokers. Lab Invest. 1975 Feb;32(2):125–132. [PubMed] [Google Scholar]
  2. Choux R., Pautrat G., Viallat J., Farisse P., Boutin C. Inorganic cytoplasmic inclusions in alveolar macrophages. The role of cigarette smoking. Arch Pathol Lab Med. 1978 Feb;102(2):79–83. [PubMed] [Google Scholar]
  3. Daniele R. P., Altose M. D., Rowlands D. T., Jr Immunocompetent cells from the lower respiratory tract of normal human lungs. J Clin Invest. 1975 Oct;56(4):986–995. doi: 10.1172/JCI108179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dreisin R. B., Schwarz M. I., Theofilopoulos A. N., Stanford R. E. Circulating immune complexes in the idiopathic interstitial pneumonias. N Engl J Med. 1978 Feb 16;298(7):353–357. doi: 10.1056/NEJM197802162980701. [DOI] [PubMed] [Google Scholar]
  5. Gadek J., Hunninghake G., Zimmerman R., Kelman J., Fulmer J., Crystal R. G. Pathogenetic studies in idiopathic pulmonary fibrosis. Control of neutrophil migration by immune complexes. Chest. 1979 Feb;75(2 Suppl):264–265. [PubMed] [Google Scholar]
  6. Haslam P. L., Thompson B., Mohammed I., Townsend P. J., Hodson M. E., Holborow E. J., Turner-Warwick M. Circulating immune complexes in patients with cryptogenic fibrosing alveolitis. Clin Exp Immunol. 1979 Sep;37(3):381–390. [PMC free article] [PubMed] [Google Scholar]
  7. Hinman L. M., Stevens C., Matthay R. A., Bernard J., Gee L. Angiotensin convertase activities in human alveolar macrophages: effects of cigarette smoking and sarcoidosis. Science. 1979 Jul 13;205(4402):202–203. doi: 10.1126/science.221980. [DOI] [PubMed] [Google Scholar]
  8. Horwitz A. L., Kelman J. A., Crystal R. G. Activation of alveolar macrophage collagenase by a neutral protease secreted by the same cell. Nature. 1976 Dec 23;264(5588):772–774. doi: 10.1038/264772a0. [DOI] [PubMed] [Google Scholar]
  9. Hunninghake G., Gadek J., Weinberger S., Kelman J., Elson N., Young R., Fulmer J., Crystal R. G. Comparison of the alveolitis of sarcoidosis and idiopathic pulmonary fibrosis. Chest. 1979 Feb;75(2 Suppl):266–267. doi: 10.1378/chest.75.2.266. [DOI] [PubMed] [Google Scholar]
  10. Johnson U., Ohlsson K., Olsson I. Effects of granulocyte neutral proteases on complement components. Scand J Immunol. 1976;5(4):421–426. doi: 10.1111/j.1365-3083.1976.tb00296.x. [DOI] [PubMed] [Google Scholar]
  11. Kravis T. C., Ahmed A., Brown T. E., Fulmer J. D., Crystal R. G. Pathogenic mechanisms in pulmonary fibrosis: collagen-induced migration inhibition factor production and cytotoxicity mediated by lymphocytes. J Clin Invest. 1976 Nov;58(5):1223–1232. doi: 10.1172/JCI108576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. König W., Czarnetzki B. M., Lichtenstein L. M. Eosinophil chemotactic factor (ECF). II. Release from human polymorphonuclear leukocytes during phagocytosis. J Immunol. 1976 Jul;117(1):235–241. [PubMed] [Google Scholar]
  13. Pratt S. A., Smith M. H., Ladman A. J., Finley T. N. The ultrastructure of alveolar macrophages from human cigarette smokers and nonsmokers. Lab Invest. 1971 May;24(5):331–338. [PubMed] [Google Scholar]
  14. Reynolds H. Y., Fulmer J. D., Kazmierowski J. A., Roberts W. C., Frank M. M., Crystal R. G. Analysis of cellular and protein content of broncho-alveolar lavage fluid from patients with idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonitis. J Clin Invest. 1977 Jan;59(1):165–175. doi: 10.1172/JCI108615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Reynolds H. Y., Newball H. H. Analysis of proteins and respiratory cells obtained from human lungs by bronchial lavage. J Lab Clin Med. 1974 Oct;84(4):559–573. [PubMed] [Google Scholar]
  16. Tai P. C., Spry C. J. Studies on blood eosinophils. I. Patients with a transient eosinophilia. Clin Exp Immunol. 1976 Jun;24(3):415–422. [PMC free article] [PubMed] [Google Scholar]
  17. Turner-Warwick M., Burrows B., Johnson A. Cryptogenic fibrosing alveolitis: clinical features and their influence on survival. Thorax. 1980 Mar;35(3):171–180. doi: 10.1136/thx.35.3.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Turner-Warwick M., Haslam P., Weeks J. Antibodies in some chronic fibrosing lung diseases. II. Immunofluorescent studies. Clin Allergy. 1971 Jun;1(2):209–219. doi: 10.1111/j.1365-2222.1971.tb03020.x. [DOI] [PubMed] [Google Scholar]
  19. Wahl L. M., Wahl S. M., Mergenhagen S. E., Martin G. R. Collagenase production by lymphokine-activated macrophages. Science. 1975 Jan 24;187(4173):261–263. doi: 10.1126/science.163038. [DOI] [PubMed] [Google Scholar]
  20. Weinberger S. E., Kelman J. A., Elson N. A., Young R. C., Jr, Reynolds H. Y., Fulmer J. D., Crystal R. G. Bronchoalveolar lavage in interstitial lung disease. Ann Intern Med. 1978 Oct;89(4):459–466. doi: 10.7326/0003-4819-89-4-459. [DOI] [PubMed] [Google Scholar]

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