Bronchoalveolar lavage in children with cystic fibrosis: how many lobes should be sampled? | Archives of Disease in Childhood

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Bronchoalveolar lavage in children with cystic fibrosis: how many lobes should be sampled?

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ERS guidelines for bronchoalveolar lavage in children with cystic fibrosis should not be abandoned
Andrew T Hughes
Published on: 13 April 2011

Published on: 13 April 2011
ERS guidelines for bronchoalveolar lavage in children with cystic fibrosis should not be abandoned
- Andrew T Hughes
- Other Contributors:
  Andrew Hughes (1), Claire Wainwright (2), Margaret Rosenfeld (3), Sarath Ranganathan (4)
We read with interest the recent paper by Gilchrist et al(1) that looked at the issue of how many lobes should be sampled by bronchoalveolar lavage (BAL) in children with cystic fibrosis (CF). There is little evidence to guide our practice in this area.
We note that the majority of the BAL results analysed in their study were taken from symptomatic patients, but it is unclear whether the BALs were performed du...
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We read with interest the recent paper by Gilchrist et al(1) that looked at the issue of how many lobes should be sampled by bronchoalveolar lavage (BAL) in children with cystic fibrosis (CF). There is little evidence to guide our practice in this area.
We note that the majority of the BAL results analysed in their study were taken from symptomatic patients, but it is unclear whether the BALs were performed during what would be defined as an infective pulmonary exacerbation. The authors state that of the 56 organisms identified from these cultures, only 15 had been identified by surveillance cultures in the same patients over the preceding 4 months. In children of the age range reported (5.3 to 11.5 years) sputum cultures are usually obtained and, it would be useful to know how results from BAL and sputum cultures taken during the same symptomatic period differed. In our opinion, if a positive sputum culture result was available there would have been no clear justification for performing a BAL in these patients. If sputum is not obtained, sputum induction is a useful way of avoiding general anaesthesia in children of this age.
We are also doubtful of the benefits of 'therapeutic lavage', which was the rationale provided for the practice of performing BAL from multiple lobes in the study. The authors reported that there were no clinically significant adverse events during the BALs, and that the incidence of post-bronchoscopy fever was in line with other published data. However, as the median age of children in this study was 8.5 years, we are concerned that this safety profile is not transferable to younger children and infants with CF, in whom, because of the difficulty in obtaining sputum samples, BALs are more often performed. The risks of BAL are greater in younger patients and we would not recommend that multiple lavages be performed in infants and pre-school children without consideration of the increased risks in this group.(2)This study illustrates that BAL sampling from one or two lobes does not provide the complete microbiological picture in CF, but this needs to be weighed up against the possible adverse effects of sampling more than two lobes, especially in younger children, and the opportunities to reach a microbiological diagnosis using alternative methods to obtain cultures. Therefore, these results should not be taken to suggest that the most recent European Respiratory Society guidelines recommending two lobe lavages should be abandoned, especially in younger children.(3)
(1)Gilchrist FJ, Salamat S, Clayton S, Peach J, Alexander J, Lenney W. Bronchoalveolar lavage in children with cystic fibrosis: how many lobes should be sampled? Arch Dis Child 2011;96: 215-217
(2)Wainwright C et al. Safety of Bronchoalveolar Lavage in Young Children with Cystic Fibrosis. Pediatric Pulmonology 2008;43:965-972
(3)Brennan S, Gangell C, Wainwright C, Sly P. Disease surveillance using bronchoalveolar lavage. Paediatr Respir Rev 2008;9:151-159
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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