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Comparative study between bronchoalveolar lavage and induced sputum in the diagnosis of inflammatory lung diseases

Abstract

Background

Airway sampling is implicated in the workup of inflammatory lung diseases.

Objective

The aim of this study was to compare between induced sputum (IS) and bronchoalveolar lavage (BAL) in the diagnosis of inflammatory (including infectious) lung diseases regarding safety, cell composition (total and differential), microbiology workup, and cytology.

Patients and methods

This was a prospective comparative study that was carried out between February 2015 and February 2016. We enrolled 30 patients with inflammatory (including infiltrative and infectious) lung diseases whom presented to the Chest Department of Alexandria Main University Hospital. IS was performed in all included patients by inhalation of hypertonic saline (3%), using an ultrasonic nebulizer. In the same cohort, BAL was performed using flexible bronchoscopy within 1 week of IS. Samples from both techniques were sent for cytological (total and differential cell counts), microbiological, and cytopathological workup.

Results

The study sample included 26 (86.7%) female and 4 (13.3%) male patients. Their mean age was 43.57±16.30 years. BAL samples were more voluminous than IS samples (52.83±18.69 and 15.33±5.03 ml, respectively; P<0.001). Total cell counts were significantly higher in IS than in BAL (292.5 and 105.5 cell/cm2, respectively; P<0.001). No statistically significant differences were noted between both groups regarding the differential cell counts, culture results, or cytology. Complications in the form of hemorrhage occurred in two (6.67%) patients during BAL. No complications were recorded in the IS group.

Conclusion

IS is comparable to BAL. Although BAL is more voluminous, the total cell count in IS is higher. No differences were noted between both techniques regarding differential cell count, culture, and cytology results. IS is safe and can replace BAL in the workup of inflammatory, including infiltrative and infectious, lung diseases.

References

  1. Pin I, Gibson PG, Kolendowicz R, Girgis-Gabardo A, Denburg JA, Hargreave FE, et al. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax 1992; 47: 25–29.

    CAS  Article  Google Scholar 

  2. Bickerman HA, Sproul EE, Barach AL. An aerosol method of producing bronchial secretions in human subject a clinical technique for the detection of lung cancer. Dis Chest 1958; 33:347–362.

    CAS  Article  Google Scholar 

  3. Fireman E, Lerman Y. Possible future of induced sputum in interstitial lung disease. Eur Respir J 2000; 15:240–242.

    CAS  Article  Google Scholar 

  4. Fireman E, Topilsky I, Greif J, Lerman Y, Schwarz Y, Man A, Topilsky M. Induced sputum compared to bronchoalveolar lavage for evaluating patients with sarcoidosis and non-granulomatous interstitial lung disease. Respir Med 1999; 93:827–834.

    CAS  Article  Google Scholar 

  5. Collins AM, Rylance J, Wootton DG, Wright AD, Wright AKA, Fullerton DG, Gordon SB. Bronchoalveolar lavage (BAL) for research; obtaining adequate sample yield. J Vis Exp 2014; 85: e4345.

    Google Scholar 

  6. Rose AS, Knox KS. Bronchoalveolar lavage as a research tool. Semin Respir Crit Care Med 2007; 28:561–573.

    Article  Google Scholar 

  7. Meyer KC, Raghu G, Baughman RP, Brown KK, Costabel U, du Bois RM, et al. 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; 185:1004–1014.

    Article  Google Scholar 

  8. Cantrell ET, Warr GA, Busbee DL, Martin RR. Induction of aryl hydrocarbon hydroxylase in human pulmonary alveolar macrophages by cigarette smoking. J Clin Invest 1973; 52:1881–1884.

    CAS  Article  Google Scholar 

  9. Spanevello A, Beghe B, Bianchi A, Migliori GB, Ambrosetti M, Neri M, Ind PW. Comparison of two methods of processing induced sputum: selected versus entire sputum. Am J Respir Crit Care Med 1998; 157:665–668.

    CAS  Article  Google Scholar 

  10. Alexis NE, Hu SC, Zemen K, Alter T, Bennett WD. Induced sputum derives from the central airways: confirmation using a radiolabeled aerosol bolus delivery technique. Am J Respir Crit Care Med 2001; 164:1964–1970.

    CAS  Article  Google Scholar 

  11. Hunter CJ, Ward R, Woltmann G, Wardlaw AJ, Pavord ID. The safety and success rate of sputum induction using a low output ultrasonic nebuliser. Respir Med 1999; 93:345–348.

    CAS  Article  Google Scholar 

  12. Raghu G, Nyberg F, Morgan G. The epidemiology of interstitial lung disease and its association with lung cancer. Br J Cancer 2004; 91: S3–S10.

    Article  Google Scholar 

  13. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med 2002; 165: 277–304.

  14. Sobiecka M, Kus J, Demkow U, Filewska M, Jozwik A, Radwan- Rohrenschef P, Chorostowska-Wynimko J. Induced sputum in patients with interstitial lung disease: a non-invasive surrogate for certain parameters in bronchoalveolar lavage fluid. J Physiol Pharmacol 2008; 59:645–657.

    PubMed  Google Scholar 

  15. Olivieri D, D’Ippolito R, Chetta A. Induced sputum: diagnostic value in interstitial lung disease. Curr Opin Pulm Med 2000; 6:411–414.

    CAS  Article  Google Scholar 

  16. Pavord ID, Sterk PJ, Hargreave FE, Kips JC, Inman MD, Louis R, et al. Clinical applications of assessment of airway inflammation using induced sputum. Eur Respir J Suppl 2002; 37:40s–43s.

    CAS  PubMed  Google Scholar 

  17. Rytila P, Metso T, Petays T, Sohlman A, Tyolahti H, Kohonen-Jalonen P, et al. Eosinophilic airway inflammation as an underlying mechanism of undiagnosed prolonged cough in primary healthcare patients. Respir Med 2002; 96:52–58.

    CAS  Article  Google Scholar 

  18. Green RH, Brightling CE, Woltmann G, Parker D, Wardlaw AJ, Pavord ID. Analysis of induced sputum in adults with asthma: identification of subgroup with isolated sputum neutrophilia and poor response to inhaled corticosteroids. Thorax 2002; 57:875–879.

    CAS  Article  Google Scholar 

  19. Rutgers SR, Timens W, Kaufmann HF, van der Mark TW, Koeter GH, Postma DS. Comparison of induced sputum with bronchial wash, bronchoalveolar lavage and bronchial biopsies in COPD. Eur Respir J 2000; 15:109–115.

    CAS  Article  Google Scholar 

  20. Louis R, Lau LC, Bron AO, Roldaan AC, Radermecker M, Djukanović R. The relationship between airways inflammation and asthma severity. Am J Respir Crit Care Med 2000; 161:9–16.

    CAS  Article  Google Scholar 

  21. Louis R, Shute J, Biagi S, Stanciu L, Marrelli F, Tenor H, et al. Cell infiltration, ICAM-1 expression, and eosinophil chemotactic activity in asthmatic sputum. Am J Respir Crit Care Med 1997; 155:466–472.

    CAS  Article  Google Scholar 

  22. Pavord ID, Brightling CE, Woltmann G, Wardlaw AJ. Non-eosinophilic corticosteroid unresponsive asthma. Lancet 1999; 353:2213–2214.

    CAS  Article  Google Scholar 

  23. Brightling CE, Ward R, Gob KL, Wardlaw AJ, Pavord ID. Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med 1999; 160:406–410.

    CAS  Article  Google Scholar 

  24. Siergiejko Z. Bronchoalveolar lavage and induced sputum in asthmatic and COPD patients. Pol Merkur Lekarski 2003; 14:545–547.

    PubMed  Google Scholar 

  25. Maestrelli P, Calcagni PG, Saetta M, Di Stefano A, Hosselet JJ, Santonastaso A, et al. Sputum eosinophilia after asthmatic responses induced by isocyanates in sensitized subjects. Clin Exp Allergy 1994; 24:29–34.

    CAS  Article  Google Scholar 

  26. Michaylov MA, Pressyanov DS, Kalinov KB. Bronchial dysplasia induced by radiation in miners exposed to 222Rn progeny. Occup Environ Med 1995; 52:82–85.

    CAS  Article  Google Scholar 

  27. Fireman E, Topilsky I, Greif J, Lerman Y, Schwarz Y, Man A, et al. Induced sputum compared to bronchoalveolar lavage for evaluating patients with sarcoidosis and non-granulomatous interstitial lung disease. Respir Med 1999; 93:827–834.

    CAS  Article  Google Scholar 

  28. D’Ippolito R, Foresi A, Chetta A, Casalini A, Castagnaro A, Leone C, et al. Induced sputum in patients with newly diagnosed sarcoidosis: comparison with bronchial wash and BAL. Chest 1999; 115:1611–1615.

    Article  Google Scholar 

  29. D’Ippolito R, Chetta A, Foresi A, Marangio E, Castagnaro A, Merliniaft S, et al. Induced sputum and bronchoalveolar lavage from patients with hypersensitivity pneumonitis. Respir Med 2004; 98:977–983.

    Article  Google Scholar 

  30. Lam S, Leriche JC, Kijek K, Phillips D. Effect of bronchial lavage volume on cellular and protein recovery. Chest 1985; 88:856–859.

    CAS  Article  Google Scholar 

  31. Reynolds HY. Bronchoalveolar lavage. Am Rev Respir Dis 1987; 135:250–263.

    CAS  PubMed  Google Scholar 

  32. Berger HW, Mejia E. Tuberculous pleurisy. Chest 1973; 63:88–92.

    CAS  Article  Google Scholar 

  33. Conde MB, Loivos AC, Rezende VM, Soares LM, Mello FC, Reingold AL, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med 2003; 167:723–725.

    Article  Google Scholar 

  34. Parry CM, Kamato O, Harries AD, Wirima JJ, Nyirenda CM, Nyangulu DS, Hart CA. The use of sputum induction for establishing a diagnosis in patients with suspected pulmonary tuberculosis in Malawi. Tuber Lung Dis 1995; 76:72–76.

    CAS  Article  Google Scholar 

  35. Larosgue RC, Katz JT, Perruzzi P, Baden LR. The utility of sputum induction for diagnosis of pneumocystis pneumonia in immunocompromised patients without human immunodeficiency virus. Clin Infect Dis 2003; 37:1380–1383.

    Article  Google Scholar 

  36. Zar HJ, Tannenbaum E, Hanslo D, Hussey G. Sputum induction as a diagnostic tool for community-acquired pneumonia in infants and young children from a high HIV prevalence area. Pediatr Pulmonol 2003; 36:58–62.

    CAS  Article  Google Scholar 

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Correspondence to Ayman I. Baess MD, PhD.

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Soliman Atta, M.S., Baess, A.I. & Mohammad Abdullah, M.H. Comparative study between bronchoalveolar lavage and induced sputum in the diagnosis of inflammatory lung diseases. Egypt J Bronchol 11, 81–87 (2017). https://doi.org/10.4103/ejb.ejb_78_16

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Keywords

  • bronchoalveolar lavage
  • induced sputum
  • infiltrative lung diseases
  • inflammatory lung diseases