BRONCHOALVEOLAR CELLS IN ADVANCED PULMONARY SARCOIDOSIS

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Abstract
Bronchoalveolar lavage (BAL) was performed in 120 subjects: 94 patients with sarcoidosis, 11 patients with idiopathic pulmonary fibrosis (IPF) and 15 normal volunteers. By counting cells and comparing the results with those from control subjects, a high percentage of lymphocytes was found in BAL fluid from all patients with sarcoidosis and a high percentage of neutrophils (NE) was found in BAL fluid from patients with IPF. There was also a significantly higher proportion of NE in the 14 patients with advanced sarcoidosis (i.e., fibrosis and bullous radiological patterns) than was seen in the 80 patients with early stages of involvement (i.e., bilateral hilar lymphadenopathy and/or pulmonary infiltrations) (P < 0.001). NE count exceeded the normal value of 3.5% in 9 of the 14 patients with advanced sarcoidosis but in only 1 of the 80 patients with early disease (P < 0.001). Apparently, advanced sarcoidosis is one of the conditions in which a simultaneous increase in NE and lymphocytes in BAL fluid can be observed. NE count in bronchoalveolar fluid in patients with sarcoidosis, as in patients with IPF, may indicate evolution of the granulomatous process toward pulmonary fibrosis. These phenomena indicate the potential practical value of iterative BAL in patients with sarcoidosis in assessing the prognosis of their disease.

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