LOWER RESPIRATORY-TRACT INFLAMMATION IN CHRONIC-BRONCHITIS - EVALUATION BY BRONCHOALVEOLAR LAVAGE AND CHANGES ASSOCIATED WITH TREATMENT WITH IMMUCYTAL, A BIOLOGICAL RESPONSE MODIFIER

Chronic bronchitis (CB) is characterized by inflammatory changes in th e bronchial tissue and by recurrent bronchitis exacerbations. In addit ion, defective systemic and local immune mechanisms have been demonstr ated and biologic response modifiers (BRMs) have been recently introdu ced for clinical use in patients with CB. We studied 24 patients with CB by bronchoalveolar lavage (BAL), before and after a 4-week treatmen t protocol with inhaled Immucytal (Pierre-Fabre Pharma Srl, Milan, Ita ly), a BRM composed of bacterial ribosomal fractions and membrane prot eoglycanes. Compared with normal controls (NC), before treatment BAL i n patients with CB contained increased proportions of neutrophils (NC, 0.8 +/- 0.2 percent; CB, 3 +/- 1 percent), of eosinophils (NC, 0.1 +/ - 0.02 percent; CB, 0.6 +/- 0.2 percent); and of lymphocytes (NC, 6 +/ - 1 percent; CB, 13 +/- 2 percent; p<0.01 each comparison) with higher percentages of CD3(+) and CD8(+) lymphocytes (p<0.01 each comparison) . In BAL from patients with CB there were also higher levels of albumi n and of the ratio IgG/ albumin (p<0.01 and p<0.05, respectively, comp ared with NC). After Immucytal treatment, the proportions of lymphocyt es in BAL in patients with CB were decreased (13 +/- 2 percent before, 6 +/- 1 percent after; p<0.01). In addition, the posttreatment BAL sa mples contained significantly fewer neutrophils per milliliter of BAL (3.7 +/- 0.8x10(3) neutrophils per milliliter of BAL before, 1.5 +/- 0 .5X10(3) neutrophils per milliliter after; p<0.05). No differences wer e seen for the proportions of lymphocyte subpopulations and for the pr otein levels between the BAL obtained before and after Immucytal treat ment. These data demonstrate the presence of a lower respiratory tract inflammation in patients with CB and suggest that treatment of patien ts with CB with a BRM may change the proportions of inflammatory cells present in BAL.