Download PDF
Semin Respir Crit Care Med 2007; 28(5): 546-560
DOI: 10.1055/s-2007-991527
© Thieme Medical Publishers

Bronchoalveolar Lavage as a Diagnostic Tool

Keith C. Meyer1
  • 1Department of Medicine, Section of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Further Information

Publication History

Publication Date:
02 November 2007 (online)

    Permissions and Reprints

ABSTRACT

Bronchoalveolar lavage (BAL) provides an important diagnostic tool that can facilitate the diagnosis of various diffuse lung diseases. BAL fluid can be analyzed to determine white blood cell (WBC) profiles and to detect respiratory pathogens. Although BAL is seldom useful as a “stand-alone” diagnostic test for the diagnosis of diffuse infiltrative lung disease, when combined with clinical data and high-resolution computed tomography of the chest, BAL WBC profiles can contribute significantly to the diagnosis of specific forms of interstitial lung disease (ILD). Additionally, BAL can play a very important role in the diagnosis of respiratory infection, and it is useful in monitoring the lung allograft and in evaluating pediatric lung disease. Examination of BAL cells or acellular components of BAL via gene microarray technology or proteomic analyses may allow BAL to assume a more prominent role in diagnosis and management of lung disease in the near future.

KEYWORDS

Bronchoalveolar lavage (BAL) - interstitial lung disease (ILD) - bronchoscopy

REFERENCES

  • 1 Klech H, Pohl W Technical recommendations and guidelines for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Group on BAL. Eur Respir J 1989 2: 561-585
    Google Scholar
  • 2 Klech H, Hutter C Clinical guidelines and indications for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Group on BAL. Eur Respir J 1990 3: 937-969
    Google Scholar
  • 3 The BAL Co-operative Group Steering Committee . Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups.  Am Rev Respir Dis. 1990;  141(Suppl 5) S169-S202
    PubMedGoogle Scholar
  • 4 Klech H, Hutter C, Costabel U Clinical guidelines and indication for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Group on BAL. Eur Respir Rev 1992 2: 47-127
    Google Scholar
  • 5 Haslam PL, Baughman RP Guidelines for the measurement of acellular components and recommendations for standardization of bronchoalveolar lavage (BAL). Eur Respir Rev 1999 9: 25-157
    Google Scholar
  • 6 American Thoracic Society . Clinical role of bronchoalveolar lavage in adults with pulmonary disease.  Am Rev Respir Dis. 1990;  142 481-486
    PubMedGoogle Scholar
  • 7 Martin T R, Raghu G, Maunder R J et al.. The effects of chronic bronchitis and chronic air-flow obstruction on lung cell populations recovered by bronchoalveolar lavage.  Am Rev Respir Dis. 1985;  132 254-260
    PubMedGoogle Scholar
  • 8 Baughman R P, Spencer R E, Kleykamp B O, Rashkin M C, Douthit M M. Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield.  Eur Respir J. 2000;  16 1152-1157
    CrossrefPubMedGoogle Scholar
  • 9 Dhillon D P, Haslam P L, Townsend P J et al.. Bronchoalveolar lavage in patients with interstitial lung diseases: side effects and factors affecting fluid recovery.  Eur J Respir Dis. 1986;  68 342-350
    PubMedGoogle Scholar
  • 10 Costabel U, Guzman J. Effect of smoking on bronchoalveolar lavage constituents.  Eur Respir J. 1992;  5 776-779
    PubMedGoogle Scholar
  • 11 Meyer K C. Neutrophils and low-grade inflammation in the seemingly normal aging human lung.  Mech Ageing Dev. 1998;  104 169-181
    CrossrefPubMedGoogle Scholar
  • 12 Meyer K C, Soergel P. Bronchoalveolar lymphocyte phenotypes change in the normal aging human lung.  Thorax. 1999;  54 697-700
    CrossrefPubMedGoogle Scholar
  • 13 Lee B E, Robinson J L, Khurana V, Pang X L, Preiksaitis J, Fox J D. Enhanced identification of viral and atypical bacterial pathogens in lower respiratory tract samples with nucleic acid amplification tests.  J Med Virol. 2006;  78 702-710
    CrossrefPubMedGoogle Scholar
  • 14 Hohenthal U, Itälä M, Salonen J et al.. Bronchoalveolar lavage in immunocompromised patients with haematological malignancy: value of new microbiological methods.  Eur J Haematol. 2005;  74 203-211
    CrossrefPubMedGoogle Scholar
  • 15 Palacios G, Quan P-L, Jabado O J et al.. Panmicrobial oligonucleotide array for diagnosis of infectious diseases. Emerg Infect Dis 2007 [12 Jan 2006] Available from http://www.cdc.gov/EID/13/1/73/htm
    Google Scholar
  • 16 Chen N H, Liu Y C, Tsao T C et al.. Combined bronchoalveolar lavage and polymerase chain reaction in the diagnosis of pulmonary tuberculosis in smear-negative patients.  Int J Tuberc Lung Dis. 2002;  6 350-355
    PubMedGoogle Scholar
  • 17 Peikert T, Rana S, Edell E S. Safety, diagnostic yield, and therapeutic imiplications of flexible bronchoscopy in patients with febrile neutropenia and pulmonary infiltrates.  Mayo Clin Proc. 2005;  80 1414-1420
    PubMedGoogle Scholar
  • 18 Ninane V. Bronchoscopic invasive diagnostic techniques in the cancer patient.  Curr Opin Oncol. 2001;  13 236-241
    CrossrefPubMedGoogle Scholar
  • 19 Joos L, Chhajed P N, Wallner J et al.. Pulmonary infections diagnosed by BAL: a 12-year experience in 1066 immunocompromised patients.  Respir Med. 2007;  101 93-97
    CrossrefPubMedGoogle Scholar
  • 20 Jain P, Sandur S, Meli Y, Arroliga A C, Stoller J K, Mehta A C. Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates.  Chest. 2004;  125 712-722
    CrossrefPubMedGoogle Scholar
  • 21 Boersma W G, Erjavec Z, van der Werf T S, de Vries-hosper H G, Gouw A SH, Manson W L. Bronchoscopic diagnosis of pulmonary infiltrates in granulocytopenic patients with hematologic malignancies: BAL versus PSB and PBAL.  Respir Med. 2007;  101 317-325
    CrossrefPubMedGoogle Scholar
  • 22 Sternberg R I, Baughman R P, Dohn M N, First M R. Utility of bronchoalveolar lavage in assessing pneumonia in immunosuppressed renal transplant recipients.  Am J Med. 1993;  95 358-364
    CrossrefPubMedGoogle Scholar
  • 23 Lehto J T, Anttila V J, Lommi J et al.. Clinical usefulness of bronchoalveolar lavage in heart transplant recipients with suspected lower respiratory tract infection.  J Heart Lung Transplant. 2004;  23 570-576
    CrossrefPubMedGoogle Scholar
  • 24 Meduri G U, Wunderink R G, Leeper Jr K V, Beals D H. Management of bacterial pneumonia in ventilated patients: protected bronchoalveolar lavage as a diagnostic tool.  Chest. 1992;  101 500-508
    PubMedGoogle Scholar
  • 25 Ioanas M, Ferrer R, Angrill J, Ferrer M, Torres A. Microbial investigation in ventilator-associated pneumonia.  Eur Respir J. 2001;  17 791-801
    CrossrefPubMedGoogle Scholar
  • 26 Clec'h C, Jauréguy F, Hamza L et al.. Agreement between quantitative cultures of postintubation tracheal aspiration and plugged telescoping catheter, protected specimen brush, or BAL for the diagnosis of nosocomial pneumonia.  Chest. 2006;  130 956-961
    CrossrefPubMedGoogle Scholar
  • 27 The Canadian Critical Care Trials Group . A randomized trial of diagnostic techniques for ventilator-associated pneumonia.  N Engl J Med. 2006;  355 2619-2630
    CrossrefPubMedGoogle Scholar
  • 28 Baughman R P, Drent M. Role of bronchoalveolar lavage in interstitial lung disease.  Clin Chest Med. 2001;  22 331-341
    CrossrefPubMedGoogle Scholar
  • 29 Meyer K C. The role of bronchoalveolar lavage in interstitial lung disease.  Clin Chest Med. 2004;  25 637-649
    CrossrefPubMedGoogle Scholar
  • 30 Baughman R P. Is bronchoalveolar lavage clinically useful for everyday practice in interstitial lung disease? Con: bronchoalveolar lavage.  J Bronchology. 1999;  6 211-216
    PubMedGoogle Scholar
  • 31 Raghu G. Is bronchoalveolar lavage clinically useful for everyday practice in interstitial lung disease? Con: bronchoalveolar lavage.  J Bronchology. 1999;  6 217-221
    PubMedGoogle Scholar
  • 32 Costabel U, Guzman J. Bronchoalveolar lavage in interstitial lung disease.  Curr Opin Pulm Med. 2001;  7 255-261
    CrossrefPubMedGoogle Scholar
  • 33 Costabel U, Guzman J. Bronchoalveolar lavage. In: Schwartz MI, King TE Jr Interstitial Lung Disease. Hamilton, ON; BC Decker 2003: 114-133
    Google Scholar
  • 34 Welker L, Jorres R A, Costabel U, Magnussen H. Predictive value of BAL cell differentials in the diagnosis of interstitial lung diseases.  Eur Respir J. 2004;  24 1000-1006
    CrossrefPubMedGoogle Scholar
  • 35 Drent M, Jacobs J A. Bronchoalveolar lavage. In: Baughman RP, Du Bois RM, Lynch JP III, Wells AU Diffuse Lung Disease: A Practical Approach. New York; Oxford University Press 2004: 56-64
    Google Scholar
  • 36 Hunninghake G W, Crystal R G. Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity.  N Engl J Med. 1981;  305 429-432
    CrossrefPubMedGoogle Scholar
  • 37 Costabel U, Zaiss A W, Guzman J. Sensitivity and specificity of BAL findings in sarcoidosis.  Sarcoidosis. 1992;  9(Suppl 1) 211-214
    PubMedGoogle Scholar
  • 38 Winterbauer R H, Lammert J, Selland M et al.. Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis.  Chest. 1993;  104 352-361
    CrossrefPubMedGoogle Scholar
  • 39 Kantrow S P, Meyer K C, Kidd P et al.. The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis.  Eur Respir J. 1997;  10 2716-2721
    CrossrefPubMedGoogle Scholar
  • 40 Auerswald U, Barth J, Magnussen H. Value of CD1 positive cells in bronchoalveolar lavage fluid for the diagnosis of pulmonary histiocytosis X.  Lung. 1991;  169 305-309
    CrossrefPubMedGoogle Scholar
  • 41 Allen J N, Davis W B. Eosinophilic lung diseases.  Am J Respir Crit Care Med. 1994;  150 1423-1438
    CrossrefPubMedGoogle Scholar
  • 42 Pope-Harman A L, Davis W B, Allen E D et al.. Acute eosinophilic pneumonia: a summary of 15 cases and review of the literature.  Medicine (Baltimore). 1996;  75 334-342
    CrossrefPubMedGoogle Scholar
  • 43 Fontenot A P, Schwarz M I. Diffuse alveolar hemorrhage. In: Schwartz MI, King TE Jr Interstitial Lung Disease. Hamilton, ON; BC Decker 2003: 632-656
    Google Scholar
  • 44 Martin R J, Coalson J J, Rogers R M et al.. Pulmonary alveolar proteinosis: the diagnosis by segmental lavage.  Am Rev Respir Dis. 1980;  121 819-825
    PubMedGoogle Scholar
  • 45 Joint Statement of the American Thoracic Society (ATS) . Idiopathic pulmonary fibrosis: diagnosis and treatment: international consensus statement.  Am J Respir Crit Care Med. 2000;  161 646-664
    Google Scholar
  • 46 Hunninghake G W, Lynch D A, Galvin J R et al.. Radiologic findings are strongly associated with a pathologic diagnosis of usual interstitial pneumonia.  Chest. 2003;  124 1215-1223
    CrossrefPubMedGoogle Scholar
  • 47 Lynch D A, Godwin Jr D, Safrin S et al.. High-resolution computed tomography in idiopathic pulmonary fibrosis: diagnosis and prognosis.  Am J Respir Crit Care Med. 2005;  172 488-493
    CrossrefPubMedGoogle Scholar
  • 48 Shah P L, Hansell D, Lawson P R, Reid K B, Morgan C. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis.  Thorax. 2000;  55 67-77
    CrossrefPubMedGoogle Scholar
  • 49 Haslam P L, Dewar A, Butchers P et al.. Mast cells, atypical lymphocytes, and neutrophils in bronchoalveolar lavage in extrinsic allergic alveolitis: comparison with other interstitial lung diseases.  Am Rev Respir Dis. 1987;  135 35-47
    PubMedGoogle Scholar
  • 50 Drent M, van Velzen Blad H, Diamant M et al.. Bronchoalveolar lavage in extrinsic allergic alveolitis: effect of time elapsed since antigen exposure.  Eur Respir J. 1993;  6 1276-1281
    PubMedGoogle Scholar
  • 51 Lynch J PD, Standiford T J, Rolfe M W et al.. Neutrophilic alveolitis in idiopathic pulmonary fibrosis: the role of initerleukin-8.  Am Rev Respir Dis. 1992;  145 1433-1439
    PubMedGoogle Scholar
  • 52 Haslam P L, Turton C W, Lukoszek A et al.. Bronchoalveolar lavage fluid cell counts in cryptogenic fibrosing alveolitis and their relation to therapy.  Thorax. 1980;  35 328-339
    CrossrefPubMedGoogle Scholar
  • 53 Rudd R M, Haslam P L, Turner-Warwick M. Cryptogenic fibrosing alveolitis: relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and prognosis.  Am Rev Respir Dis. 1981;  124 1-8
    PubMedGoogle Scholar
  • 54 Watters L C, Schwarz M I, Cherniack R M et al.. Idiopathic pulmonary fibrosis: pretreatment bronchoalveolar lavage cellular constituents and their relationships with lung histopathology and clinical response to therapy.  Am Rev Respir Dis. 1987;  135 696-704
    PubMedGoogle Scholar
  • 55 Peterson M W, Monick M, Hunninghake G W. Prognostic role of eosinophils in pulmonary fibrosis.  Chest. 1987;  92 51-56
    CrossrefPubMedGoogle Scholar
  • 56 Drent M, Macobs J A, de Vries J et al.. Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis?.  Eur Respir J. 1999;  13 1338-1344
    CrossrefPubMedGoogle Scholar
  • 57 Schwartz D A, Helmers R A, Galvin J R et al.. Determinants of survival in idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med. 1994;  149 450-454
    CrossrefPubMedGoogle Scholar
  • 58 Ryu Y J, Chung M P, Han J et al.. Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias.  Respir Med. 2007;  101 655-660
    CrossrefPubMedGoogle Scholar
  • 59 De Vuyst P, Dumortier P, Moulin E et al.. Asbestos bodies in bronchoalveolar lavage reflect lung asbestos body concentration.  Eur Respir J. 1988;  1 362-367
    PubMedGoogle Scholar
  • 60 Dodson R F, Garcia J G, O'Sullivan M, Corn C et al.. The usefulness of bronchoalveolar lavage in identifying past occupational exposure to asbestos: a light and electron microscopy study.  Am J Ind Med. 1991;  19 619-628
    CrossrefPubMedGoogle Scholar
  • 61 Fireman E, Greif J, Schwarz Y et al.. Assessment of hazardous dust exposure by BAL and induced sputum.  Chest. 1999;  115 1720-1728
    CrossrefPubMedGoogle Scholar
  • 62 Perna F, Iavarone M, Skrimpas S, Mazzarella G, Sanduzzi A. Detection and qualitative identification of mineral fibers and particles in alveolar macrophages of BAL fluid by SEM and EDXA.  Monaldi Arch Chest Dis. 2002;  57 193-195
    PubMedGoogle Scholar
  • 63 Christman J W, Emerson R J, Graham W G, Davis G S. Mineral dust and cell recovery from the bronchoalveolar lavage of healthy Vermont granite workers.  Am Rev Respir Dis. 1985;  132 393-399
    PubMedGoogle Scholar
  • 64 Michetti G, Mosconi G, Zanelli R et al.. Bronchoalveolar lavage and its role in diagnosing cobalt lung disease.  Sci Total Environ. 1994;  150 173-178
    CrossrefPubMedGoogle Scholar
  • 65 Rossman M D, Kern J A, Elias J A et al.. Proliferative response of bronchoalveolar lymphocytes to beryllium: a test for chronic beryllium disease.  Ann Intern Med. 1988;  108 687-693
    CrossrefPubMedGoogle Scholar
  • 66 Lam B, Wong M P, Ooi C et al.. Diagnostic yield of bronchoscopic sampling methods in bronchial carcinoma.  Respirology. 2000;  5 265-270
    CrossrefPubMedGoogle Scholar
  • 67 Wongsurakiat P, Wongbunnate S, Dejsomritrutai W et al.. Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer.  Respirology. 1998;  3 131-137
    PubMedGoogle Scholar
  • 68 Tang C C, Hsiao C J, Chen H et al.. Value of bronchoalveolar lavage combined with transbronchial lung biopsy in the diagnosis of peripheral lung cancer.  Chang Gung Med J. 2000;  23 695-700
    PubMedGoogle Scholar
  • 69 Schwarz M I. Miscellaneous interstitial lung diseases. In: Schwarz MI, King TE Jr Interstitial Lung Disease. Hamilton, ON; BC Decker 2003: 877-916
    Google Scholar
  • 70 Springmeyer S C, Hackman R, Carlson J J, McClellan J E. Bronchioloalveolar cell carcinoma diagnosed by bronchoalveolar lavage.  Chest. 1983;  83 278-279
    PubMedGoogle Scholar
  • 71 Keicho N, Oka T, Takeuchi K, Yamane A, Yazaki Y, Yotsumoto H. Detection of lymphomatous involvement of the lung by bronchoalveolar lavage: application of immunophenotypic and gene rearrangement analysis.  Chest. 1994;  105 458-462
    PubMedGoogle Scholar
  • 72 Zompi S, Couderc L J, Cadranel J et al.. Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma.  Blood. 2004;  103 3208-3215
    CrossrefPubMedGoogle Scholar
  • 73 Tiroke A H, Bewig B, Haverich A. Bronchoalveolar lavage in lung transplantation.  Clin Transplant. 1999;  13 131-157
    CrossrefPubMedGoogle Scholar
  • 74 Meyer K C. The role of neutrophils in transplantation. In: Wilkes DS, Burlingham WJ Immunobiology of Organ Transplantation. New York; Kluwer/Plenum 2004: 493-507
    Google Scholar
  • 75 Meyer K C, Nunley D R, Dauber J et al.. Neutrophils, unopposed neutrophil elastase and alpha-1-antiprotease defenses following human lung transplantation.  Am J Respir Crit Care Med. 2001;  164 97-102
    CrossrefPubMedGoogle Scholar
  • 76 Bowdish M E, Arcasoy S M, Wilt J S et al.. Surrogate markers and risk factors for chronic lung allograft dysfunction.  Am J Transplant. 2004;  4 1171-1178
    CrossrefPubMedGoogle Scholar
  • 77 Lu B S, Yu A D, Zhu X, Garrity Jr E R, Vigneswaran W T, Bhorade S M. Sequential gene expression profiling in lung transplant recipients with chronic rejection.  Chest. 2006;  130 847-854
    CrossrefPubMedGoogle Scholar
  • 78 Zhang Y, Wroblewski M, Hertz M I, Wendt C H, Cervenka T M, Nelsestuen G L. Analysis of chronic lung transplant rejection by MALDI-TOF profiles of bronchoalveolar lavage fluid.  Proteomics. 2006;  6 1001-1010
    CrossrefPubMedGoogle Scholar
  • 79 Gimino V J, Lande J D, Berryman T R, King R A, Hertz M I. Gene expression profiling of bronchoalveolar lavage cells in acute lung rejection.  Am J Respir Crit Care Med. 2003;  168 1237-1242
    CrossrefPubMedGoogle Scholar
  • 80 Valentine V G, Taylor D E, Dhillon G S et al.. Success of lung transplantation without surveillance bronchoscopy.  J Heart Lung Transplant. 2002;  21 319-326
    CrossrefPubMedGoogle Scholar
  • 81 Palmer S M, Miralles A P, Howell D N et al.. Gastroesophageal reflux as a reversible cause of allograft dysfunction after lung transplantation.  Chest. 2000;  118 1214-1217
    CrossrefPubMedGoogle Scholar
  • 82 Farrell S, McMaster C, Gibson D, Shields M D, McCallion W A. Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux-related pulmonary aspiration.  J Pediatr Surg. 2006;  41 289-293
    CrossrefPubMedGoogle Scholar
  • 83 Ratjen F, Bredendick M, Brendel M et al.. Differential cytology of bronchoalveolar lavage fluid in normal children.  Eur Respir J. 1994;  7 1865-1870
    CrossrefPubMedGoogle Scholar
  • 84 Ratjen F, Bredendick M, Zheng L et al.. Lymphocyte subsets in bronchoalveolar lavage fluid of children without bronchopulmonary disease.  Am J Respir Crit Care Med. 1995;  152 174-178
    PubMedGoogle Scholar
  • 85 Midulla F, Villani A, Merolla R et al.. Bronchoalveolar lavage studies in children without parenchymal lung disease: cellular constituents and protein levels.  Pediatr Pulmonol. 1995;  20 112-118
    CrossrefPubMedGoogle Scholar
  • 86 Ratjen F, Bruch J. Adjustment of bronchoalveolar lavage volume to body weight in children.  Pediatr Pulmonol. 1996;  21 184-188
    CrossrefPubMedGoogle Scholar
  • 87 Fan L L, Lum Lung M C, Wagener J S. The diagnostic value of bronchoalveolar lavage in immunocompetent children with chronic diffuse pulmonary infiltrates.  Pediatr Pulmonol. 1997;  23 8-13
    CrossrefPubMedGoogle Scholar
  • 88 Colombo J L, Hallberg T K. Recurrent aspiration in children: lipid-laden alveolar macrophage quantitation.  Pediatr Pulmonol. 1987;  3 86-89
    CrossrefPubMedGoogle Scholar
  • 89 Ahrens P, Noll C, Kitz R et al.. Lipid-laden alveolar macrophages (LLAM): a useful marker of silent aspiration in children.  Pediatr Pulmonol. 1999;  28 83-88
    PubMedGoogle Scholar
  • 90 Bauer M L, Lyrene R K. Chronic aspiration in children: evaluation of the lipid-laden macrophage index.  Pediatr Pulmonol. 1999;  28 94-100
    CrossrefPubMedGoogle Scholar
  • 91 Chang A B, Cox N C, Purcell J et al.. Airway cellularity, lipid laden macrophages and microbiology of gastric juice and airways in children with reflux oesophagitis.  Respir Res. 2005;  15 72
    PubMedGoogle Scholar
  • 92 Meyer K C, Sharma A. Regional lung inflammation in cystic fibrosis.  Am J Respir Crit Care Med. 1997;  156 1536-1540
    PubMedGoogle Scholar
  • 93 Konstan M W, Hilliard K A, Norvell T M, Berger M. Bronchoalveolar lavage findings in cystic fibrosis patients with stable, clinically mild lung disease suggest ongoing infection and inflammation.  Am J Respir Crit Care Med. 1994;  150 448-454
    PubMedGoogle Scholar
  • 94 Khan T Z, Wagener J S, Bost T, Martinez J, Accurso F J, Riches D WH. Early pulmonary inflammation in infants with cystic fibrosis.  Am J Respir Crit Care Med. 1995;  151 1075-1082
    PubMedGoogle Scholar
  • 95 Armstrong D S, Grimwood K, Carzino R, Carlin J B, Olinsky A, Phelan P D. Lower respiratory infection and inflammation in infants with newly diagnosed cystic fibrosis.  BMJ. 1995;  310 1571-1572
    PubMedGoogle Scholar
  • 96 Rosenfeld M, Gibson R, McNamara S et al.. Early pulmonary infection, inflammation, and clinical outcomes in infants with cystic fibrosis.  Pediatr Pulmonol. 2001;  32 356-366
    CrossrefPubMedGoogle Scholar
  • 97 Rosenfeld M, Emerson J, Accurso F et al.. Diagnostic accuracy of oropharyngeal cultures in infants and young children with cystic fibrosis.  Pediatr Pulmonol. 1999;  28 321-328
    CrossrefPubMedGoogle Scholar
  • 98 Baughman R P, Keeton D, Perez C, Wilmott R. Use of bronchoalveolar lavage semiquantitative cultures in cystic fibrosis.  Am J Respir Crit Care Med. 1997;  156 286-291
    PubMedGoogle Scholar
  • 99 Hilliard T N, Sukhani S, Francis J et al.. Bronchoscopy following diagnosis with Cystic Fibrosis.  Arch Dis Child. 2007;  92 898-899
    CrossrefPubMedGoogle Scholar
  • 100 Wainwright C. Bronchoalveolar lavage to guide management of lung disease in children with cystic fibrosis.  Pediatr Pulmonol. 2006;  29(Suppl) 188-189
    PubMedGoogle Scholar
  • 101 Agostini C, Miorin M, Semenzato G. Gene expression profile analysis by DNA microarrays: a new approach to assess functional genomics in diseases.  Sarcoidosis Vasc Diffuse Lung Dis. 2002;  19 5-9
    PubMedGoogle Scholar
  • 102 Kaminski N, Rosas I O. Gene expression profiling as a window into idiopathic pulmonary fibrosis pathogenesis: can we identify the right target genes?.  Proc Am Thorac Soc. 2006;  3 339-344
    CrossrefPubMedGoogle Scholar
  • 103 Bowler R P, Ellison M C, Reisdorph N. Proteomics in pulmonary medicine.  Chest. 2006;  130 567-574
    CrossrefPubMedGoogle Scholar
  • 104 Lenz A G, Meyer B, Costabel U, Maier K. Bronchoalveolar lavage fluid proteins in human lung disease: analysis by two-dimensional electrophoresis.  Electrophoresis. 1993;  14 242-244
    CrossrefPubMedGoogle Scholar
  • 105 Uebelhoer M, Bewig B, Oldigs M et al.. Protein profile in bronchoalveolar lavage fluaid from patients with sarcoidosis and idiopathic pulmonary fibrosis as revealed by SDS-PAGE electrophoresis and western blot analysis.  Scand J Clin Lab Invest. 1993;  53 617-623
    PubMedGoogle Scholar
  • 106 Wattiez R, Hermans C, Cruyt C, Bernard A, Falmagne P. Human bronchoalveolar lavage fluid protein two-dimensional database: study of interstitial lung diseases.  Electrophoresis. 2000;  21 2703-2712
    CrossrefPubMedGoogle Scholar
  • 107 Magi B, Bini L, Perari M G et al.. Bronchoalveolar lavage fluid protein composition in patients with sarcoidosis and idiopathic pulmonary fibrosis: a two-dimensional electrophoretic study.  Electrophoresis. 2002;  23 3434-3444
    CrossrefPubMedGoogle Scholar
  • 108 Rottoli P, Magi B, Perari M G et al.. Cytokine profile and proteome analysis in bronchoalveolar lavage of patients with sarcoidosis, pulmonary fibrosis associated with systemic sclerosis and idiopathic pulmonary fibrosis.  Proteomics. 2005;  5 1423-1430
    CrossrefPubMedGoogle Scholar
  • 109 Sabounchi-Schütt F, Mikko M, Eklund A, Grunewald J, Aström J. Serum protein pattern in sarcoidosis analysed by a proteomics approach.  Sarcoidosis Vasc Diffuse Lung Dis. 2004;  21 182-190
    PubMedGoogle Scholar
  • 110 de Torre C, Ying S, Munson P J, Meduri G U, Suffredini A F. Proteomic analysis of inflammatory biomarkers in bronchoalveolar lavage.  Proteomics. 2006;  6 3949-3957
    CrossrefPubMedGoogle Scholar
  • 111 Cosgrove G P, Brown K K, Schiemann W P et al.. Pigment epithelium-derived factor in idiopathic pulmonary fibrosis: a role in aberrant angiogenesis.  Am J Respir Crit Care Med. 2004;  170 242-251
    CrossrefPubMedGoogle Scholar
  • 112 Zuo F, Kaminski N, Eugui E et al.. Gene expression analysis reveals matrilysin as a key regulator of pulmonary fibrosis in mice and humans.  Proc Natl Acad Sci USA. 2002;  99 6292-6297
    CrossrefPubMedGoogle Scholar
  • 113 Pardo A, Gibson K, Cisneros J et al.. Up-regulation and profibrotic role of osteopontin in human idiopathic pulmonary fibrosis.  PLoS Med. 2005;  2 e251
    CrossrefPubMedGoogle Scholar
  • 114 Thonhofer R, Maercker C, Popper H H. Expression of sarcoidosis related genes in lung lavage cells.  Sarcoidosis Vasc Diffuse Lung Dis. 2002;  19 59-65
    PubMedGoogle Scholar
  • 115 Selman M, Pardo A, Barrera L et al.. Gene expression profiles distinguish idiopathic pulmonary fibrosis from hypersensitivity pneumonitis.  Am J Respir Crit Care Med. 2006;  173 188-198
    CrossrefPubMedGoogle Scholar
  • 116 Rutherford R M, Kehren J, Staedtler F et al.. Functional genomics in sarcoidosis: reduced or increased apoptosis?.  Swiss Med Wkly. 2001;  131 459-470
    PubMedGoogle Scholar
  • 117 Rutherford R M, Staedtler F, Kehren J et al.. Functional genomics and prognosis in sarcoidosis: the critical role of antigen presentation.  Sarcoidosis Vasc Diffuse Lung Dis. 2004;  21 10-18
    PubMedGoogle Scholar
  • 118 Kadota J, Mizunoe S, Mito K et al.. High plasma concentrations of osteopontin in patients with interstitial pneumonia.  Respir Med. 2005;  99 111-117
    PubMedGoogle Scholar

Keith C MeyerM.D. M.S. F.A.C.P. F.C.C.P. 

Department of Medicine, Section of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health

K4/926 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-9988

Email: kcm@medicine.wisc.edu

      >