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Updated: Oct 10, 2025
Bronchoalveolar Lavage BAL for Research; Obtaining Adequate Sample Yield
Published on: March 24, 2014
Benefits and risks of bronchoalveolar lavage in severe asthma in children
Raja Ben Tkhayat1, Jessica Taytard1,2, Harriet Corvol1,3
1APHP, Sorbonne Université, Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France.
Insights
Bronchoalveolar lavage (BAL) during pediatric severe asthma investigations offers limited management impact and can decrease procedure tolerance, especially in certain patients. BAL may reveal bacterial infections but rarely alters treatment plans.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Investigation
Background:
- Flexible bronchoscopy is used in severe pediatric asthma, but the role of bronchoalveolar lavage (BAL) remains unclear.
- This study investigated if systematic BAL improves severe asthma characterization and management in children.
Purpose of the Study:
- To evaluate the diagnostic yield and clinical impact of bronchoalveolar lavage (BAL) in children with severe asthma.
- To assess the safety and tolerance of BAL during flexible bronchoscopy in this population.
Main Methods:
- Retrospective analysis of 203 children undergoing flexible bronchoscopy for severe asthma exploration.
- 107 children had bronchoalveolar lavage (BAL) performed; data on cell counts, infections, and therapeutic modifications were analyzed.
Main Results:
- BAL revealed increasing eosinophils with age and identified bacterial infections more frequently (1.5x increase) than bronchial aspiration, particularly in nonatopic patients.
- Therapeutic changes occurred only for azithromycin and omalizumab prescriptions.
- BAL decreased procedure tolerance, especially in patients with tracheobronchial malacia or current symptoms.
Conclusions:
- Bronchoalveolar lavage (BAL) provides some information for severe asthma characterization but has limited impact on patient management.
- BAL can be poorly tolerated and should be avoided in children with tracheobronchial malacia or active asthma symptoms.
Background:
Although bronchoscopy can be part of the exploration of severe asthma in children, the benefit of bronchoalveolar lavage (BAL) is unknown. The present study aimed to decipher whether systematic BAL during a flexible bronchoscopy procedure could better specify the characteristics of severe asthma and improve asthma management.
Material And Methods:
The study took place in two departments of a university hospital in Paris. Children who underwent flexible bronchoscopy for the exploration of severe asthma between April 2017 and September 2019 were retrospectively included.
Results:
In total, 203 children were included, among whom 107 had a BAL. BAL cell count was normal in most cases, with an increasing number of eosinophils with age, independently from the atopic status of the patients. Compared with bronchial aspiration only, BAL increased the rate of identified bacterial infection by 1.5. Nonatopic patients had more bacterial infections (p<0.001). BAL induced a therapeutic modification only for azithromycin and omalizumab prescriptions. The practice of a BAL decreased bronchoscopy tolerance (p=0.037), especially in the presence of tracheobronchial malacia (p<0.01) and when performed in a symptomatic patient (p=0.019).
Discussion And Conclusion:
Although BAL may provide interesting information in characterising severe asthma, in most cases its impact on the patient's management remains limited. Moreover, BAL can be poorly tolerated and should be avoided in the case of tracheobronchial malacia or current asthma symptoms.
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