Imperial College London
Alternate

Professor Toby Maher

Faculty of Medicine, National Heart & Lung Institute

Professor of Interstitial Lung Disease
 
 
 
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Contact

 

+44 (0)20 7594 2151t.maher

 
 
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Assistant

 

Ms Georgina Moss +44 (0)20 7594 2151

 
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Location

 

364Sir Alexander Fleming BuildingSouth Kensington Campus

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Summary

 

Publications

Citation

BibTex format

@article{Barnett:2023:10.1164/rccm.202305-0796OC,
author = {Barnett, JL and Maher, TM and Quint, JK and Adamson, A and Wu, Z and Smith, DJF and Rawal, B and Nair, A and Walsh, SLF and Desai, SR and George, PM and Kokosi, M and Jenkins, G and Kouranos, V and Renzoni, EA and Rice, A and Nicholson, AG and Chua, F and Wells, AU and Molyneaux, PL and Devaraj, A},
doi = {10.1164/rccm.202305-0796OC},
journal = {American Journal of Respiratory and Critical Care Medicine},
pages = {975--982},
title = {Combination of BAL and computed tomography differentiates progressive and non-progressive fibrotic lung diseases},
url = {http://dx.doi.org/10.1164/rccm.202305-0796OC},
volume = {208},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Rationale: Identifying patients with pulmonary fibrosis (PF) at risk of progression can guide management. Objectives: To explore the utility of combining baseline BAL and computed tomography (CT) in differentiating progressive and nonprogressive PF. Methods: The derivation cohort consisted of incident cases of PF for which BAL was performed as part of a diagnostic workup. A validation cohort was prospectively recruited with identical inclusion criteria. Baseline thoracic CT scans were scored for the extent of fibrosis and usual interstitial pneumonia (UIP) pattern. The BAL lymphocyte proportion was recorded. Annualized FVC decrease of >10% or death within 1 year was used to define disease progression. Multivariable logistic regression identified the determinants of the outcome. The optimum binary thresholds (maximal Wilcoxon rank statistic) at which the extent of fibrosis on CT and the BAL lymphocyte proportion could distinguish disease progression were identified. Measurements and Main Results: BAL lymphocyte proportion, UIP pattern, and fibrosis extent were significantly and independently associated with disease progression in the derivation cohort (n = 240). Binary thresholds for increased BAL lymphocyte proportion and extensive fibrosis were identified as 25% and 20%, respectively. An increased BAL lymphocyte proportion was rare in patients with a UIP pattern (8 of 135; 5.9%) or with extensive fibrosis (7 of 144; 4.9%). In the validation cohort (n = 290), an increased BAL lymphocyte proportion was associated with a significantly lower probability of disease progression in patients with nonextensive fibrosis or a non-UIP pattern. Conclusions: BAL lymphocytosis is rare in patients with extensive fibrosis or a UIP pattern on CT. In patients without a UIP pattern or with limited fibrosis, a BAL lymphocyte proportion of 25% was associated with a lower likelihood of progression.
AU  - Barnett,JL
AU  - Maher,TM
AU  - Quint,JK
AU  - Adamson,A
AU  - Wu,Z
AU  - Smith,DJF
AU  - Rawal,B
AU  - Nair,A
AU  - Walsh,SLF
AU  - Desai,SR
AU  - George,PM
AU  - Kokosi,M
AU  - Jenkins,G
AU  - Kouranos,V
AU  - Renzoni,EA
AU  - Rice,A
AU  - Nicholson,AG
AU  - Chua,F
AU  - Wells,AU
AU  - Molyneaux,PL
AU  - Devaraj,A
DO  - 10.1164/rccm.202305-0796OC
EP  - 982
PY  - 2023///
SN  - 1073-449X
SP  - 975
TI  - Combination of BAL and computed tomography differentiates progressive and non-progressive fibrotic lung diseases
T2  - American Journal of Respiratory and Critical Care Medicine
UR  - http://dx.doi.org/10.1164/rccm.202305-0796OC
UR  - https://www.ncbi.nlm.nih.gov/pubmed/37672028
UR  - https://doi.org/10.1164/rccm.202305-0796OC
VL  - 208
ER  -
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