BACKGROUNDS: Bronchoalveolar lavage (BAL) is generally regarded as a safe diagnostic procedure. However, acute exacerbation after BAL is increasingly recognized as a specific complication for patients with idiopathic pulmonary fibrosis (IPF). So far little is known about the correlation between BAL and acute exacerbation of IPF (AE-IPF). METHODS: A cohort of 112 IPF patients at a single institution was analyzed retrospectively. We defined BAL-related AE-IPF as development of AE-IPF within 30 days after the procedure. The incidence rate of AE-IPF per person-month during the post-BAL period was compared with that after the post-BAL period. The relative risk was estimated as the former rate divided by the latter. We also reviewed the previous literature. RESULTS: Four AE-IPF cases occurred during the 201 person-month post-BAL period. The risk of AE-IPF was significantly elevated within 30 days after BAL (rate ratio = 4.12; 95% CI = 1.03-12.2). None of the 111 initial BAL procedures were followed by AE-IPF within a month. In a post hoc analysis, the relative risk of developing AE after second or later BAL procedures was estimated to be considerably higher (rate ratio = 9.10; 95% CI = 2.27-26.98). Twelve cases of BAL-induced AE-IPF were found in our study and in the literature review. Among them, nine showed moderate to severe functional impairment, and eight had either findings of leukocytosis, positive C-reactive protein, or neutrophilia in BAL. CONCLUSIONS: These results suggest that IPF patients should be carefully monitored after BAL, especially those with functional impairment or active inflammation.
BACKGROUNDS: Bronchoalveolar lavage (BAL) is generally regarded as a safe diagnostic procedure. However, acute exacerbation after BAL is increasingly recognized as a specific complication for patients with idiopathic pulmonary fibrosis (IPF). So far little is known about the correlation between BAL and acute exacerbation of IPF (AE-IPF). METHODS: A cohort of 112 IPF patients at a single institution was analyzed retrospectively. We defined BAL-related AE-IPF as development of AE-IPF within 30 days after the procedure. The incidence rate of AE-IPF per person-month during the post-BAL period was compared with that after the post-BAL period. The relative risk was estimated as the former rate divided by the latter. We also reviewed the previous literature. RESULTS: Four AE-IPF cases occurred during the 201 person-month post-BAL period. The risk of AE-IPF was significantly elevated within 30 days after BAL (rate ratio = 4.12; 95% CI = 1.03-12.2). None of the 111 initial BAL procedures were followed by AE-IPF within a month. In a post hoc analysis, the relative risk of developing AE after second or later BAL procedures was estimated to be considerably higher (rate ratio = 9.10; 95% CI = 2.27-26.98). Twelve cases of BAL-induced AE-IPF were found in our study and in the literature review. Among them, nine showed moderate to severe functional impairment, and eight had either findings of leukocytosis, positive C-reactive protein, or neutrophilia in BAL. CONCLUSIONS: These results suggest that IPF patients should be carefully monitored after BAL, especially those with functional impairment or active inflammation.
Authors: Philip L Molyneaux; Jonathan J Smith; Peter Saunders; Felix Chua; Athol U Wells; Elisabetta A Renzoni; Andrew G Nicholson; William A Fahy; R Gisli Jenkins; Toby M Maher Journal: Am J Respir Crit Care Med Date: 2021-01-01 Impact factor: 21.405
Authors: Kelvin K W To; Sally C Y Wong; Ting Xu; Rosana W S Poon; Ka-Yi Mok; Jasper F W Chan; Vincent C C Cheng; Kwok-Hung Chan; Ivan F N Hung; Kwok-Yung Yuen Journal: J Clin Microbiol Date: 2013-02-13 Impact factor: 5.948
Authors: Nikhil Hirani; Alison C MacKinnon; Lisa Nicol; Paul Ford; Hans Schambye; Anders Pedersen; Ulf J Nilsson; Hakon Leffler; Tariq Sethi; Susan Tantawi; Lise Gravelle; Robert J Slack; Ross Mills; Utsa Karmakar; Duncan Humphries; Fredrik Zetterberg; Lucy Keeling; Lyn Paul; Philip L Molyneaux; Feng Li; Wendy Funston; Ian A Forrest; A John Simpson; Michael A Gibbons; Toby M Maher Journal: Eur Respir J Date: 2021-05-27 Impact factor: 16.671