Interlobar differences in bronchoalveolar lavage fluid from children with cystic fibrosis

Bronchoalveolar lavage (BAL) performed in specialist centres has improved t he understanding of infant cystic fibrosis (CF) lung disease. As most resea rchers sample from a single lobe, it was determined whether BAL results cou ld be generalized to other lung segments. Thirty-three CF children, aged 1.5-57 months, underwent in random order seq uential BAL of their right middle and lingula lobes, Specimens from each lo be had separate quantitative bacteriology, cytology and cytokine analysis, Bacterial counts greater than or equal to1 x 10(5) colony forming units (cf u).mL(-1) were observed in nine (27%) subjects, including six involving onl y the right middle lobe, These six children had similar inflammatory indice s in their right middle and lingula lobes, and interleukin (IL)-8 concentra tions in the latter mere significantly higher than that observed within the lingula lobes of the 24 CF children with bacterial counts <1 x 10(5) cfu.m l(-1). Lingula neutrophil and IL-8 levels correlated best with right middle lobe bacteria numbers. This observational study in cystic fibrosis children suggests that while in flammation is detected in both lungs, bacterial distribution may be more in homogeneous, Bronchoalveolar lavage microbiological findings from a single lobe may therefore, not be generalized to other lung segments. When perform ing bronchoalveolar lavage in cystic fibrosis children, it is important to sample from multiple sites.