THE POTENTIAL OF BRONCHOALVEOLAR LAVAGE IN THE PROGNOSIS AND TREATMENT OF CONNECTIVE-VASCULAR DISEASES

Interstitial lung disease (ILD) has a poor prognosis in a significant number of patients with connective vascular disease (CVD). By bronchoa lveolar lavage fluid (BALF) analysis, ILD may be demonstrated in nearl y half of patients with CVD prior to any alteration in lung function o r chest radiograph. High neutrophil and eosinophil counts are usually associated with a high risk of functional deterioration, whereas the p resence of increased lymphocytes correlates with a better outcome. Fur thermore, initiation of therapy (steroids and/or cytotoxic agents) ear ly in the course of disease is predictive of a better response. Cell d ifferentials in bronchoalveolar lavage (BAL), together with measuremen ts of cell by-products and techniques such as high resolution computed tomography, may contribute in the near future to help characterize th ose patients with the highest risks of evolution to pulmonary fibrosis , and to determine the most favorable time in the course of the diseas e for the initiation of therapy.