Induced sputum and bronchoalveolar lavage from patients with hypersensitivity pneumonitis

D’Ippolito, Raffaele; Chetta, Alfredo; Foresi, Antonio; Marangio, Emilio; Castagnaro, Antonio; Merlini, Stefania; Zompatori, Maurizio; Olivieri, Dario

doi:10.1016/j.rmed.2004.03.007

« Previous Next »Respiratory Medicine
Volume 98, Issue 10 , Pages 977-983, October 2004

Induced sputum and bronchoalveolar lavage from patients with hypersensitivity pneumonitis

Raffaele D’Ippolito
- Section of Respiratory Diseases, Department of Clinical Sciences, University of Parma, Parma, Italy
- Corresponding author. U.O. Clinica Pneumologica, Azienda Ospedaliera ed Università di Parma, Viale Rasori 10, 43100 Parma, Italy. Tel.: +39-0521-703-490; fax: +39-0521-292-615
Alfredo Chetta
- Section of Respiratory Diseases, Department of Clinical Sciences, University of Parma, Parma, Italy
Antonio Foresi
- Respiratory Pathophysiology Laboratory, Sesto S. Giovanni Hospital, Sesto San Giovanni, Italy
Emilio Marangio
- Section of Respiratory Diseases, Department of Clinical Sciences, University of Parma, Parma, Italy
Antonio Castagnaro
- Section of Respiratory Diseases, Department of Clinical Sciences, University of Parma, Parma, Italy
Stefania Merlini
- Section of Respiratory Diseases, Department of Clinical Sciences, University of Parma, Parma, Italy
- This work is dedicated to the memory of Dr. Stefania Merlini, who died before her time.
Maurizio Zompatori
- Section of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy
Dario Olivieri
- Section of Respiratory Diseases, Department of Clinical Sciences, University of Parma, Parma, Italy

Received 29 September 2003; accepted 8 March 2004. published online 19 August 2004.

Abstract

Background and Aim: Hypersensitivity pneumonitis (HP) is an immunologically induced inflammation of the lung parenchyma, though bronchial airways may be also involved. The aim of this study was to compare the cellular profiles of induced sputum (IS) in patients with newly diagnosed HP to that of healthy subjects, and to examine the relationship between inflammatory cells from IS and BAL.

Methods: Nine HP patients and 9 healthy volunteers were studied. IS was obtained by inhalation of hypertonic saline solution in all subjects. Bronchoscopy was performed on a different occasion in all patients and in five controls.

Results: IS was well tolerated and preferred to BAL by all subjects. Both IS and BAL from HP patients showed a significant increase in total cells (P<0.02 and P<0.001) and in lymphocytes (P<0.02 and P<0.001) and a significant decrease in macrophages (P<0.05 and P<0.001), when compared with normal subjects. In HP patients, total cells number in IS was higher than that in BAL (P<0.02). Moreover, the percentage of lymphocytes was significantly lower in IS than in BAL (P<0.001). No significant relationship was found between total cells or inflammatory cells from IS and the corresponding ones from BAL and wide limits of agreement were found between lymphocytes from IS and BAL.

Conclusions: This study demonstrated that both BAL and IS from newly diagnosed HP patients contained significantly more total cells and lymphocytes, when compared to healthy subjects. Moreover, differential cell counts in HP patients showed that IS and BAL reflected different compartments of inflammation. Thus, IS could represent a complementary, but not alternative tool to bronchoscopy both in research and in the clinical monitoring of HP patients.

Keywords: Hypersensitivity pneumonitis, Induced sputum, Bronchoscopy, BAL