Correlation of Bronchoalveolar Lavage Lymphocyte Count with the Extent of Lung Fibrosis and with Plethysmographic Lung Volumes in Patients with Newly Recognized Hypersensitivity Pneumonitis

Overview

Journal Cent Eur J Immunol

Publisher Termedia

Specialty Allergy & Immunology

Date 2021 Jan 13

PMID 33437179

Citations 4

Authors

Monika Szturmowicz

Inga Baranska

Agnieszka Skoczylas

Malgorzata E Jedrych

Urszula Demkow

Affiliations

Soon will be listed here.

Abstract

Introduction: Hypersensitivity pneumonitis (HP) is an increasingly recognized interstitial lung disease, presenting with elevated total cell counts and high percentage of lymphocytes in bronchoalveolar lavage fluid (BALF). Despite many publications, there is no consensus in the literature concerning BALF cellular composition in patients with prolonged course of HP.

Aim: The aim of the present retrospective study was to investigate the influence of disease duration, smoking habits, and the extent of lung fibrosis on BALF cells' population in patients with newly recognized HP.

Material And Methods: In total, 94 patients (49 females, 45 males), mean age 52 (±12) years, with HP recognized according to recently proposed criteria, were enrolled into the present study. Chest CT scans were retrospectively reviewed by two independent radiologists. BALF evaluation was performed as a part of routine diagnostics according to recent recommendations.

Results: Percentage of lymphocytes in BALF was significantly lower in patients with lung fibrosis (stage 1 and 2) comparing to those without lung fibrosis (stage 0). Significant correlation was also found between the percentage of BALF lymphocytes and plethysmographic lung volumes, but not with lung transfer capacity for carbon monoxide (TLCO% pred). Smoking did not influence BALF results in our study group.

Conclusions: BALF lymphocytosis correlated with the presence and the extent of lung fibrosis on chest CT as well as with plethysmographic lung volumes but did not with TLCO and smoking habits in newly recognized HP pneumonitis.

Citing Articles

Molecular Mechanisms of Neutrophil Extracellular Trap (NETs) Degradation.

Demkow U Int J Mol Sci. 2023; 24(5).

PMID: 36902325 PMC: 10002918. DOI: 10.3390/ijms24054896.

Bronchoalveolar Lavage Cell Count and Lymphocytosis Are the Important Discriminators between Fibrotic Hypersensitivity Pneumonitis and Idiopathic Pulmonary Fibrosis.

Sobiecka M, Szturmowicz M, Lewandowska K, Baranska I, Zimna K, Lyzwa E Diagnostics (Basel). 2023; 13(5).

PMID: 36900078 PMC: 10000588. DOI: 10.3390/diagnostics13050935.

Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis-Retrospective Cohort Analysis.

Lewandowska K, Baranska I, Sobiecka M, Radwan-Rohrenschef P, Dybowska M, Franczuk M Diagnostics (Basel). 2022; 12(11).

PMID: 36428827 PMC: 9689222. DOI: 10.3390/diagnostics12112767.

A Sensitive Approach to Managing Hypersensitivity Pneumonitis.

Ahlawat P, Upadhyay P, Madaan P Cureus. 2022; 14(9):e29738.

PMID: 36340528 PMC: 9621725. DOI: 10.7759/cureus.29738.

References

Murayama J, Yoshizawa Y, Ohtsuka M, Hasegawa S . Lung fibrosis in hypersensitivity pneumonitis. Association with CD4+ but not CD8+ cell dominant alveolitis and insidious onset. Chest. 1993; 104(1):38-43. DOI: 10.1378/chest.104.1.38. View

Szpechcinski A, Kopinski P, Giedronowicz D, Rozy A, Jagus P, Szolkowska M . Simple flow cytometric protocol of CD4+/CD8+ lymphocyte ratio assessment in bronchoalveolar lavage fluids from patients with interstitial lung diseases. Anal Quant Cytol Histol. 2012; 33(5):289-96. View

Tzilas V, Tzouvelekis A, Bouros E, Karampitsakos T, Ntasiou M, Katsaras M . Diagnostic value of BAL lymphocytosis in patients with indeterminate for usual interstitial pneumonia imaging pattern. Eur Respir J. 2019; 54(5). DOI: 10.1183/13993003.01144-2019. View

Pedraza-Serrano F, Jimenez-Garcia R, Lopez-de-Andres A, Hernandez-Barrera V, Sanchez-Munoz G, Puente-Maestu L . Characteristics and outcomes of patients hospitalized with interstitial lung diseases in Spain, 2014 to 2015. Medicine (Baltimore). 2019; 98(21):e15779. PMC: 6571208. DOI: 10.1097/MD.0000000000015779. View

Morell F, Villar A, Ojanguren I, Munoz X, Cruz M . Hypersensitivity Pneumonitis: Challenges in Diagnosis and Management, Avoiding Surgical Lung Biopsy. Semin Respir Crit Care Med. 2016; 37(3):395-405. DOI: 10.1055/s-0036-1580692. View

Szturmowicz M, Baranska I, Jedrych M, Bartoszuk I, Radwan-Roehrenschef P, Rozy A . Hypersensitivity pneumonitis recognised in a single pulmonary unit, between 2005 and 2015 - comparison with recently proposed diagnostic criteria. Adv Respir Med. 2019; 87(2):83-89. DOI: 10.5603/ARM.2019.0014. View

Caillaud D, Vergnon J, Madroszyk A, Melloni B, Murris M, Dalphin J . Bronchoalveolar lavage in hypersensitivity pneumonitis: a series of 139 patients. Inflamm Allergy Drug Targets. 2012; 11(1):15-9. DOI: 10.2174/187152812798889330. View

Fisher J, Kolb M, Algamdi M, Morisset J, Johannson K, Shapera S . Baseline characteristics and comorbidities in the CAnadian REgistry for Pulmonary Fibrosis. BMC Pulm Med. 2019; 19(1):223. PMC: 6880596. DOI: 10.1186/s12890-019-0986-4. View

Meyer K, Raghu G, Baughman R, Brown K, Costabel U, du Bois R . An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012; 185(9):1004-14. DOI: 10.1164/rccm.201202-0320ST. View

10.

Szturmowicz M, Garczewska B, Jedrych M, Bartoszuk I, Sobiecka M, Tomkowski W . The value of serum precipitins against specific antigens in patients diagnosed with hypersensitivity pneumonitis - retrospective study. Cent Eur J Immunol. 2020; 44(4):390-394. PMC: 7050063. DOI: 10.5114/ceji.2019.92791. View

11.

Takei R, Yamano Y, Kataoka K, Yokoyama T, Matsuda T, Kimura T . Usefulness of new diagnostic criteria for chronic hypersensitivity pneumonitis established on the basis of a Delphi survey: A Japanese cohort study. Respir Investig. 2019; 58(1):52-58. DOI: 10.1016/j.resinv.2019.10.001. View

12.

Okamoto T, Miyazaki Y, Ogura T, Chida K, Kohno N, Kohno S . Nationwide epidemiological survey of chronic hypersensitivity pneumonitis in Japan. Respir Investig. 2013; 51(3):191-9. DOI: 10.1016/j.resinv.2013.03.004. View

13.

Vasakova M, Selman M, Morell F, Sterclova M, Molina-Molina M, Raghu G . Hypersensitivity Pneumonitis: Current Concepts of Pathogenesis and Potential Targets for Treatment. Am J Respir Crit Care Med. 2019; 200(3):301-308. DOI: 10.1164/rccm.201903-0541PP. View

14.

Chiba S, Tsuchiya K, Akashi T, Ishizuka M, Okamoto T, Furusawa H . Chronic Hypersensitivity Pneumonitis With a Usual Interstitial Pneumonia-Like Pattern: Correlation Between Histopathologic and Clinical Findings. Chest. 2016; 149(6):1473-81. DOI: 10.1016/j.chest.2015.12.030. View

15.

Ando M, Konishi K, Yoneda R, Tamura M . Difference in the phenotypes of bronchoalveolar lavage lymphocytes in patients with summer-type hypersensitivity pneumonitis, farmer's lung, ventilation pneumonitis, and bird fancier's lung: report of a nationwide epidemiologic study in Japan. J Allergy Clin Immunol. 1991; 87(5):1002-9. DOI: 10.1016/0091-6749(91)90423-l. View

16.

Patel A, Ryu J, Reed C . Hypersensitivity pneumonitis: current concepts and future questions. J Allergy Clin Immunol. 2001; 108(5):661-70. DOI: 10.1067/mai.2001.119570. View

17.

Santos V, Martins N, Sousa C, Jacob M, Padrao E, Melo N . Hypersensitivity pneumonitis: Main features characterization in a Portuguese cohort. Pulmonology. 2019; 26(3):130-137. DOI: 10.1016/j.pulmoe.2019.09.004. View

18.

Morisset J, Johannson K, Jones K, Wolters P, Collard H, Walsh S . Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis: An International Modified Delphi Survey. Am J Respir Crit Care Med. 2017; 197(8):1036-1044. PMC: 6839923. DOI: 10.1164/rccm.201710-1986OC. View

19.

Lacasse Y, Girard M, Cormier Y . Recent advances in hypersensitivity pneumonitis. Chest. 2012; 142(1):208-217. DOI: 10.1378/chest.11-2479. View

20.

Vasakova M, Morell F, Walsh S, Leslie K, Raghu G . Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. Am J Respir Crit Care Med. 2017; 196(6):680-689. DOI: 10.1164/rccm.201611-2201PP. View