Bronchial lavage

Respiratory distress was noted in 2 workers exposed to greater than 40 ppm hydrogen sulfide for under 25 minutes (Spolyar 1951). In animals, impacts on the respiratory system such as increases in the cellularity and lactate dehydrogenase and alkaline phosphatase activities of bronchial lavage fluids have been seen at exposures as low as 10 ppm for 4 hours (Lopez et al. 1987) although without a dose-related trend. 

Tillie-Leblond I, Pugin J, Marquette CH, Lamblin C, Saulnier F, Brichet A, et al Balance between proinflamma-tory cytokines and their inhibitors in bronchial lavage from patients with status asthmaticus. Am J Respir Crit Care Med 1999 159 487-494. 

The effect of ozone on lysosomal enzymes has been studied by a number of investigators. Ozone has been clearly shown to inactivate lysozyme in vitro, but the effects of inhaled ozone on the activity of lysozyme appear to depend on the pulmonary fraction under study. Holzman et al. reported that exposure of rabbits or mice to ozone resulted in a decrease in the lysozyme activity of bronchopulmonary lavage samples. The effect was linearly related to product of ozone concentration and duration of exposure, although relatively high concentrations of ozone (2.0-S.S ppm) were used in this acute-exposure experiment (1-4 h). The authors also reported that alveolar cells present in the bronchial lavage of rabbits exposed to ozone at 10 ppm for 3 h had a decrease in the rate of lysosomal... 

In contradistinction to the decrease in lysosomal enzyme activity observed in alveolar macrophages and bronchial lavage fluid, Dillard et al. reported that continuous ozone exposure (0.70-0.79 ppm for 5-7 days) resulted in an increase in the activity of some lysosomal hydrolases in rat whole-lung homogenates and lung fractions, including the soluble supernatant. The tocopherol concentrations of the diet had no effect on the findings. 

The bronchial lavage of atopic subjects exhibits increased TH2 cytokine (IL-4, IL-5, IL-13) mRNA levels in both CD4+ and CD8+ T cells. 

Bronchial Lavage in Humans 149 5. Inflammatory Mediators that Increase ... 

Plasma leakage Assessed by Bronchial lavage in Humans... 

Lam, S., Leriche, J.C., Kijek, K. and Phillips, RT. (1985). Effect of bronchial lavage volume on cellular and protein recovery. Chest 88, 856-859. 

CHAN-YEUNG, M., LERICHE, J., MACLEAN, L. LAM, S. (1988) Comparison of cellular and protein changes in bronchial lavage fluid of symptomatic and asymptomatic patients with red cedar asthma on follow-up examination. Clinical Allergy 18, 359-365. 

Tillie-Lehlond 1, H Hammad, S Desurmont, J Pugin, B. WaUaert, AB Tonnel, P Gosset. 2000. CC chemokines and interleukin-5 in bronchial lavage fluid from patients with status asthmaticus. Potential implication in eosinophil recruitment. Am J Respir Crit Care Med 162 586. 

Pesci A, Balbi B, Major M, Cacciani G, Bertacco S, Alciato P, Donner CF. Inflammatory cells and mediators in bronchial lavage of patients with chronic obstructive pulmonary disease. Eur Respir J 1998 12 380-386. 

More recently there has been an increased emphasis on air pollution since episodes of pollution have been correlated with increased morbidity and mortality in susceptible groups. Here EM coupled with image analysis and microanalytical techniques gives information at different levels in the pollution pathway (Table 4). The morphology and elemental composition of particles collected from ambient air can be identified and the number and composition of particles present in bronchial lavage fluids and in alveolar macrophages determined. The technique of EELS with its ability to differentiate between oxidative states of metals such as iron, and thus assist in determination of their hazard potential, has great potential in this area. 

Clinical Investigations Diesel exhaust (mass median diameter <10 pm) at 300 pg/m associated with concentrations of NOj of 1.6 ppm, NO of 4.5 ppm for 1 h, CO of 7.5 ppm, total hydrocarbons of 4.3 ppm, formaldehyde of 0.26 mg/m and 4.3 x 10 suspended particles/ml in healthy human volunteers exposed for 1 h induced a 240 % median relative increase in interleukin-8 mRNA gene transcripts in the cells contained in bronchial lavage performed 6 h later (Salvi et al. 2000). There were no changes in the mRNA transcript levels for ILL-ip, ILL-4, TNF-a, interferon-y, and granulocyte-macrophage colony-stimulating factor after exposure to diesel exhaust compared with air. 

Thin fluid specimens (e.g. fine needle aspirations, ascitic fluids, bronchial lavages) may be concentrated by centrifugation, or diluted if very cellular, before being spread onto glass slides. Ctytospin preparations (Cytospin , Shandon Scientific Ltd.) may also be prepared these have the advantage of localizing the cells to an area of approximately 1 cm in diameter. 

AEP clinically presents as an acute febrile illness with dyspnea, pleuritic chest pain, myalgias, and respiratory failure. In AEP, blood eosinophiha is often absent, but more than 25% eosinophils are found in the bronchial lavage fluid of these patients. CEP has an insidious onset with fever, malaise, weight loss, and dyspnea. About 90% of these patients suffer from asthmatic symp-... 

Chan-Yeung et al. (42) have compared the respiratory effects in mill workers versus office workers, and Vedal et al. (178, 179) have related this to duration of exposure to the wood. Lam et al. (99) have studied cellular and protein changes in bronchial lavage fluid following late asthmatic reaction in patients with red cedar asthma. 

Bama BP, Deodhar SD, Gautam S, et al. Experimental beryllium-induced lung disease. II. Analyses of bronchial lavage cells in strains 2 and 13 guinea pigs. Int Arch Allergy Appl Immunol 1984 73(l) 49-55. 

Secretion clearance is addressed in detail elsewhere in the text. However, physical therapy and careful hydration are the cornerstones of management. Mucupurulent secretions are often noted in acute respiratory failure. Administration of acetylcysteine 600 mg/day will decrease sputum viscosity hut its value in NIV patients has been less well studied. In patients with NMD, manually assisted coughing, air stacking, and mechanical devices can all be used in patients with a facial mask. On rare occasions, bronchial lavage under local anesthesia can be carried out during NIV. Secretion clearance reduces the ventilation pressures required to overcome the impedance to airflow. 

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