Role of bronchoalveolar lavage in the diagnosis of acute exacerbations of idiopathic pulmonary fibrosis: a retrospective study

BMC Pulmonary Medicine

Anita J. Reddy¹  Daniel A. Culver¹  Frunze Petrosyan² 

[1] Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland 44195, OH, USA;Hospital Medicine Department, Johnston Health, University of North Carolina Health System, 509 N Brightleaf Blvd, Smithfield 27527, NC, USA

关键词: Acute respiratory failure;    Bronchoalveolar lavage;    Interstitial lung disease;    Idiopathic pulmonary fibrosis;   

Others  :  1219953
DOI  :  10.1186/s12890-015-0066-3

 received in 2015-03-10, accepted in 2015-06-30,  发布年份 2015

【 摘 要 】

Background

It has been recognized that despite previous stability some patients with idiopathic pulmonary fibrosis (IPF) experience acute clinical deteriorations called acute exacerbations of idiopathic pulmonary fibrosis (AEX-IPF). We hypothesized that pulmonary infection can be excluded based on clinical and laboratory data and that bronchoscopy with BAL is not mandatory in the diagnostic work-up of suspected AEX-IPF.

Methods

In this retrospective study we identified patients with acute respiratory failure who were evaluated for AEX-IPF at the Cleveland Clinic between January 2002 and December 2011. Univariate and multivariate analysis were performed with predefined risk factors and final diagnosis of AEX-IPF and pulmonary infection. All tests were performed at a significance level of 0.05.

Results

A total of 77 patients met the study inclusion criteria. Of these patients 47 (61 %) were diagnosed with AEX-IPF. Bronchoscopy was more likely to be performed in patients who were on cytotoxic medications (p < 0.05). In most cases the diagnosis of AEX-IPF versus pulmonary infection was based on combination of other microbiological, clinical, radiologic data and clinical judgment. A total of 10 patients out of 14 (71 %) with a final diagnosis of pulmonary infection were on steroids on admission versus 21 out of 63 patients (33 %) with other final diagnosis (p = 0.024, OR 7.817, 95 % CI 1.31–46.64).

Conclusions

Exclusion of infection in our IPF patient cohort was mostly based on factors other than diagnostic bronchoscopy with BAL. Based on our results we suggested an algorithm for management of IPF patients presenting with acute respiratory failure.

【 授权许可】

   
2015 Petrosyan et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Collard HR, Moore BB, Flaherty KR, Brown KK, Kaner RJ, King TE et al.. Acute exacerbations of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2007; 176(7):636-43.
• [2]Wootton SC, Kim DS, Kondoh Y, Chen E, Lee JS, Song JW et al.. Viral infection in acute exacerbation of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011; 183(12):1698-702.
• [3]Simon-Blancal V, Freynet O, Nunes H, Bouvry D, Naggara N, Brillet PY et al.. Acute exacerbation of idiopathic pulmonary fibrosis: outcome and prognostic factors. Respiration. 2012; 83(1):28-35.
• [4]Huie TJ, Olson AL, Cosgrove GP, Janssen WJ, Lara AR, Lynch DA et al.. A detailed evaluation of acute respiratory decline in patients with fibrotic lung disease: aetiology and outcomes. Respirology. 2010; 15(6):909-17.
• [5]Ding J, Chen Z, Feng K. Procalcitonin-guided antibiotic use in acute exacerbations of idiopathic pulmonary fibrosis. Int J Med Sci. 2013; 10(7):903-7.
• [6]Johannson K, Collard HR. Acute exacerbation of idiopathic pulmonary fibrosis: a proposal. Curr Respir Care Rep. 2013; 2:4.
• [7]Kondoh Y, Taniguchi H, Katsuta T, Kataoka K, Kimura T, Nishiyama O et al.. Risk factors of acute exacerbation of idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis. 2010; 27(2):103-10.
• [8]Judge EP, Fabre A, Adamali HI, Egan JJ. Acute exacerbations and pulmonary hypertension in advanced idiopathic pulmonary fibrosis. Eur Respir J. 2012; 40(1):93-100.
• [9]Meyer KC, Raghu G, Baughman RP, Brown KK, Costabel U, du Bois RM et al.. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012; 185(9):1004-14.
• [10]Pesci A, Ricchiuti E, Ruggiero R, De Micheli A. Bronchoalveolar lavage in idiopathic pulmonary fibrosis: what does it tell us? Respir Med. 2010; 104 Suppl 1:S70-3.
• [11]Papanikolaou IC, Drakopanagiotakis F, Polychronopoulos VS. Acute exacerbations of interstitial lung diseases. Curr Opin Pulm Med. 2010; 16(5):480-6.
• [12]Wuyts WA, Thomeer M, Dupont LJ, Verleden GM. An algorithm to tackle acute exacerbations in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2008; 177(12):1397.
• [13]Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK et al.. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011; 183(6):788-824.
• [14]Lee JS, Song JW, Wolters PJ, Elicker BM, King TE, Kim DS et al.. Bronchoalveolar lavage pepsin in acute exacerbation of idiopathic pulmonary fibrosis. Eur Respir J. 2012; 39(2):352-8.
• [15]Lee JS, Collard HR, Anstrom KJ, Martinez FJ, Noth I, Roberts RS et al.. Anti-acid treatment and disease progression in idiopathic pulmonary fibrosis: an analysis of data from three randomised controlled trials. Lancet Respir Med. 2013; 1(5):369-76.
• [16]Song JW, Hong SB, Lim CM, Koh Y, Kim DS. Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J. 2011; 37(2):356-63.
• [17]Schupp JC, Binder H, Jager B, Cillis G, Zissel G, Muller-Quernheim J et al.. Macrophage activation in acute exacerbation of idiopathic pulmonary fibrosis. PLoS One. 2015; 10(1):e0116775.
• [18]Kurosu K, Takiguchi Y, Okada O, Yumoto N, Sakao S, Tada Y et al.. Identification of annexin 1 as a novel autoantigen in acute exacerbation of idiopathic pulmonary fibrosis. J Immunol. 2008; 181(1):756-67.
• [19]Sakamoto K, Taniguchi H, Kondoh Y, Wakai K, Kimura T, Kataoka K et al.. Acute exacerbation of IPF following diagnostic bronchoalveolar lavage procedures. Respir Med. 2012; 106(3):436-42.
• [20]Kim DS, Park JH, Park BK, Lee JS, Nicholson AG, Colby T. Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features. Eur Respir J. 2006; 27(1):143-50.
• [21]Suga T, Sugiyama Y, Ohno S, Kitamura S. Two cases of IIP which developed acute exacerbation after bronchoalveolar lavage. Nihon Kyobu Shikkan Gakkai Zasshi. 1994; 32(2):174-8.
• [22]Hiwatari N, Shimura S, Takishima T, Shirato K. Bronchoalveolar lavage as a possible cause of acute exacerbation in idiopathic pulmonary fibrosis patients. Tohoku J Exp Med. 1994; 174(4):379-86.
• [23]Wells AU. The clinical utility of bronchoalveolar lavage in diffuse parenchymal lung disease. Eur Respir Rev. 2010; 19(117):237-41.