Bronchoalveolar lavage in children with chronic diffuse parenchymal lung disease

The aim of the present study was to compare cellular and noncellular compon ents of bronchoalveolar lavage fluid (BAL) in a group of children with a di agnosis of chronic diffuse parenchymal lung disease (cDPLD) and a group of children without parenchymal lung disease undergoing BAL for various clinic al indications (control group). We evaluated cellular and noncellular compo nents (total proteins, albumin, hyaluronic acid, and fibronectin) in BAL fl uid from 14 children (7 boys and 7 girls; mean age 9.2 years, range 5 month s to 18.4 years) fulfilling the clinical and radiological diagnosis of chro nic cDPLD, and in 19 controls without evidence of lung disease. The 14 pati ents were assigned to two study groups: early-stage cDPLD (6 patients; age range 5 months to 5.2 years; duration of illness, 5-7 months) and long-stan ding cDPLD (8 patients; age range 9.6-18.4 years; duration of illness, 1.2- 17.6 years). Ninety-three percent of the patients with cDPLD had at least two BAL consti tuents outside normal limits, with high numbers of cells, including all typ es of alveolar cells, but especially lymphocytes and foamy macrophages. The se findings indicate a mixed, predominantly lymphocytic alveolitis. Our pat ients also had a significant increase in two noncellular BAL components, na mely fibronectin and hyaluronic acid. BAL samples from children with long-s tanding cDPLD contained increased numbers of lymphocytes, whereas samples f rom children with early-stage cDPLD contained increased percentages and num bers of foamy macrophages and increased concentrations of fibronectin, hyal uronic acid, and albumin. In conclusion, we clearly identified an abnormal BAL profile in our group o f cDPLD patients. Moreover, BAL findings differentiated younger cDPLD patie nts in the early stages of their illness from old patients with long-standi ng disease. Pediatr Pulmonol, 1999;27:395-402, (C) 1999 Wiley-Liss, Inc.