The strange beginnings of diagnostic and therapeutic bronchoalveolar lavage

Bronchoalveolar lavage was originally developed as a method for the diagnosis and treatment of pulmonary alveolar proteinosis. The first technique devised, "segmental flooding", was cumbersome but effective. Samples obtained provided information about the alveolar cellular response and alveolar protein dynamics. Most importantly, "segmental flooding" showed that living lung parenchyma was not damaged by repeated irrigation with isotonic saline as some had proposed. The therapeutic success and limitations of this first method of bronchoalveolar irrigation provided the intellectual stimulus which lead to the development of therapeutic whole-lung lavage. Serial whole-lung lavages, coupled with well-timed lung biopsies, offered the first opportunity to demonstrate in man the alveolar cellular response in a disease process, the dynamics of the production and dissipation of pulmonary lipids and the functioning of the surfactant system. The new and complex studies of the lungs' cellular reactions and metabolism may be better understood in the historical context of the first observations made possible by the development of bronchoalveolar lavage.