The main objective of the study was to evaluate the relationship between the findings of the bronchoalveolar lavage (BAL) and the lung function in patients with systemic sclerosis and subsequent pulmonary impairment. The study was retrospective and included 17 cases with systemic sclerosis and pulmonary involvement investigated at "Marius Nasta" Institute. Bucharest, between January 1999-August 2001. Lung function assessment found the following: VC (% of predicted) = 82.5 +/- 14; DLCO (% of predicted) = 67.5 +/- 23.2. Cell count in BAL fluid showed: total number of cells x 10(6) = 11.5 +/- 6; lymphocytes (%) = 22.9 +/- 15.4; neutrophils (%) = 15.2 +/- 13.4; eosinophils (%) = 1.9 +/- 0.9; macrophages (%) = 58.1 +/- 19.8. We also compared the cell pattern according to DLCO value: the patients with DLCO > 80% had increased levels of eosinophils (5.2 +/- 4.9 vs 0.9 +/- 0.2, p = 0.007) while the group with DLCO < 80% presented significantly higher levels of neutrophils (16.1 +/- 15.5 vs 12.6 +/- 2.8, p = 0.003) compared to the group with normal lung function.
Conclusions: Patients with systemic sclerosis and normal lung function present an increased level of eosinophils in BAL fluid, suggesting a transitory alveolitis. In change, those with DLCO < 80% have a higher level of neutrophils, usually associated to pulmonary fibrosis. The investigation by BAL appears to be a reliable tool for the assessment of the pulmonary impairment related to systemic sclerosis.