COMPARTMENTALIZED IMMUNE-RESPONSE REFLECTS CLINICAL SEVERITY OF BERYLLIUM DISEASE

Although beryllium disease has been associated with a bronchoalveolar lavage (BAL) lymphocytosis and T cell-mediated immune response, we do not know if either the BAL cellular profile or the compartmentalized p ulmonary response to the antigen reflect the severity of the disease. We studied 110 subjects divided into three groups of subjects: berylli um disease patients (n = 55), beryllium-sensitized patients without di sease (n = 8), and control subjects (n = 47). Evaluation included comp letion of a respiratory symptom questionnaire, clinical examination, c hest radiograph, spirometry, body plethysmographic lung volumes, and d iffusing capacity (DL(CO)). In the patient groups, we performed maxima l exercise testing with an indwelling arterial line. In addition, we e xamined BAL and performed blood and BAL beryllium lymphocyte transform ation tests (BeLT) as measures of the beryllium-specific T cell-mediat ed response in these two compartments. In beryllium disease patients w e correlated the BAL cellular constituents with clinical parameters in dicative of disease severity. Beryllium disease patients exhibited ele vated numbers of white cells and lymphocytes in BAL compared with both other groups; however, this lymphocytic alveolitis was significantly obscured in smokers. The BAL cellular constituents correlated with BAL BeLT but not with the blood BeLT. BAL cellular constituents also corr elated with the radiographic profusion of small opacities, FEV(1)/FVC, DL(CO), maximal achievable work load, VO(2)max, and measures of gas e xchange at rest and at maximum exercise. We conclude that the lymphocy te-predominant pulmonary inflammatory response in beryllium disease is related to the magnitude of the localized response to antigen and tha t BAL cellularity, differential cell count, and BeLT reflect beryllium disease clinical severity. Tobacco smoking interferes with the interp retation of BAL data in this disease.