THE RELATIONSHIP BETWEEN INFECTION AND INFLAMMATION IN THE EARLY STAGES OF LUNG-DISEASE FROM CYSTIC-FIBROSIS

We examined the relationship of pulmonary infection and inflammation i n cystic fibrosis (CF) by performing 31 bronchoalveolar lavages (BAL) in 14 young children with minimal lung disease from CF. While 10 of th e 14 patients had elevated polymorphonuclear leukocyte (PMN) counts in itially, only 4 had bacteria generally regarded as pathogenic in the r ecovered BAL fluid. Three of these 4 and 6 of the others had follow-up bronchoscopies at 6 months intervals. PMN counts remained normal for only one patient. However, pathogenic bacteria were recovered during t he repeat BALs only in those patients who were colonized initially. Pr oinflammatory cytokines and proteinases were generally elevated, and i nterleukin-8 (IL-8) concentration correlated inversely with oxygen sat uration (SaO(2)). No complications of the procedure occurred. We concl ude that BAL identifies inflammation and the presence of bacteria in t he lower airway at an early stage of the disease. This information may be used to guide therapy in patients too young or otherwise unable to produce sputum. These data also suggest that inflammation is present early in the course of CF lung disease before colonization and infecti on of the lungs with potentially pathogenic bacteria occurs. Since inf lammation appears to be the earliest detectable evidence of lung disea se in CF, monitoring of inflammation with BAL may serve as a useful ma rker of clinical benefits from new treatments in patients with minimal lung disease. (C) 1995 Wiley-Liss, Inc.