Contribution of lymphocyte-dominant bronchoalveolar lavage to disease management and treatment in interstitial lung diseases

Objectives: BAL is one of the diagnostic methods in interstitial lung diseases when used together with clinical, laboratory and radiological methods. Lymphocyte-dominant BAL is used to make a specific diagnosis, to narrow the differential diagnosis spectrum and to predict the response to treatment. In this study, we aimed to evaluate the contribution of lymphocyte-dominat BAL to disease management and response to treatment. Patients and Methods: Patients who were pre-diagnosed with interstitial lung disease and have lymphocyte-dominant BAL (n=75) were included in the study. Patient's demographic data, laboratory, spirometric, radiological findings and BAL results were analyzed. Results: Percentage of the male patients included in the study was 46,7% and the mean age was 49,81±15,66 (18-78). The majority of the patients were diagnosed as sarcoidosis (n=26), hypersensitivity pneumonia (n=11) and idiopathic interstitial pneumonia (n=10). But 4% of the total patients could not be diagnosed. The rate of eosinophils in BAL was higher in patients diagnosed with idiopathic interstitial pneumonia and connective tissue disease-related interstitial lung disease (p=0,006). None of the BAL result of sarcoidosis patients was eosinophil dominant and mixed pattern (p=0,006, p=0,049). Eosinophil dominant BAL was higher in patients with consolidation pattern (p=0,006). Mixed pattern was higher in BAL with patients who has consolidation and reticular pattern; mixed pattern was not observed in BAL in any of the patients with nodular pattern (p=0,018). 58.3% of the patients were received steroid treatment. There was no statistically significant difference in BAL results related to steroid treatment. Patients with ground-glass and nodular pattern had better response to treatment (p=0,021). FVC were higher in the first 6 months and DLCO were higher in the 6-12 months follow-up in patients who responded well to teratment (p=0,031, p=0,076). Conclusion: BAL can be diagnostic when performed with appropriate technique and combined with clinical, laboratory and radiological methods. Only lymphocyte predominance in BAL in the diagnosis of sarcoidosis is helpful. Regardless of cell type predominancy, BAL does not predict response to treatment. In order to evaluate the response to treatment, it is more appropriate to follow the patients with FVC in the first 6 months and DLCO in 6-12 months.