Is bronchoscopic lung biopsy helpful in the management of patients with diffuse lung disease?

Few studies have evaluated how the results of bronchoscopic lung biopsy (BLB) affect clinical management. The objective of the present study was to evaluate the clinical usefulness of BLB in the overall management of patients with diffuse pulmonary diseases. The study was a retrospective analysis of patients who underwent fluoroscopy-guided BLB over a 2-yr period. Patients whose biopsy was of a lung mass or single dominant lung nodule were excluded. The usefulness of BLB was assessed to determine whether the results affected the clinical management of these patients. During the study period, 603 patients underwent 651 BLB procedures. The results of BLB were clinically helpful in 494 (75.9%) out of 651 procedures. No diagnostic abnormality was identified in 107 (16.4%) out of the 651 biopsy procedures. This finding was clinically helpful in 59 (55.1%) out of 107 procedures, as the results excluded specific processes suspected before BLB. In 52 procedures (8% of all BLB), no lung parenchyma was obtained. In conclusion, bronchoscopic lung biopsy is a clinically useful test in approximately 75% of procedures. In the 25% of bronchoscopic lung biopsies that were clinically unhelpful, the reason for failure in approximately one-third of patients was the failure of the procedure to obtain an adequate quantity of lung parenchyma for a meaningful histological analysis.

Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis.

Recently, granulocyte-macrophage colony-stimulating factor (GM-CSF) auto-antibodies have been found in many patients with pulmonary alveolar proteinosis (PAP). The present study reports a retrospective case series of patients who used aerosolised GM-CSF in the treatment of idiopathic PAP. Between 1999 and 2003, 12 patients elected to receive aerosolised GM-CSF (250 microg b.i.d. every other week) in lieu of whole-lung lavage or observation. Patient characteristics, pulmonary function tests, arterial blood gas analysis, laboratory values and chest radiographs were extracted from the patient's medical records. Of the six patients tested, all had GM-CSF neutralising antibodies. Additionally, abnormalities in GM-CSF gene expression (one patient), receptor expression (two patients) and ability to upregulate adhesion molecules (one patient) were found. All patients except one had a positive response (mean improvements in arterial oxygen tension, alveolar-arterial oxygen gradient, carbon monoxide diffusing capacity of the lung and forced vital capacity were 17.1 mmHg, 18.4 mmHg, 16.6% pred and 13.5% pred, respectively). Two patients made a complete recovery and were disease free 1 and 2 yrs after discontinuing treatment. Four patients showed complete response to both the initial course or when treated again for recurrence after discontinuation of treatment. One patient required dose escalation (500 microg b.i.d.) with complete response. GM-CSF was well tolerated without late toxicity after median (range) follow-up of 30.5 (3-68) months. In conclusion, aerosolised granulocyte-macrophage colony-stimulating factor is safe and effective in treating pulmonary alveolar proteinosis providing an alternative to whole-lung lavage or subcutaneous granulocyte-macrophage colony-stimulating factor.