• Koji Sakamoto, Hiroyuki Taniguchi, Yasuhiro Kondoh, Kenji Wakai, Tomoki Kimura, Kensuke Kataoka, Naozumi Hashimoto, Osamu Nishiyama, and Yoshinori Hasegawa.
• Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan.
• Respir Med. 2012 Mar 1; 106 (3): 436-42.

BackgroundsBronchoalveolar 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).MethodsA 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.ResultsFour 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.ConclusionsThese results suggest that IPF patients should be carefully monitored after BAL, especially those with functional impairment or active inflammation.Copyright © 2011 Elsevier Ltd. All rights reserved.

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