Prognostic significance of bronchoalveolar lymphocytosis in farmer's lung

In 1983, we studied and reported the clinical and bronchoalveolar lavage (BAL) data of 26 patients with a history of previous farmer's lung. Most of these subjects (24 of 26) had a BAL lymphocytosis. In 1985, we restudied 14 of these subjects. Each subject had a clinical evaluation, chest roentgenogram, pulmonary function tests, and bronchoalveolar lavage. Results show that only 1 subject had evidence of an episode of acute recurrent disease, and only 1 had clinically progressive disease; however, 6 complained of chronic cough and sputum production. There were some fluctuations in individual pulmonary functions, with a significant decrease in FVC during the 2-yr period. The total number of cells on repeated lavage was 55.20 X 10(6) +/- 41.10 X 10(6) (mean +/- SD). This was not statistically different from the results obtained 2 yr earlier (69.5 X 10(6) +/- 43.01 X 10(6)). The percentage of BAL lymphocytes was also similar between the 2 studies, with abnormal values (greater than 20%) in 13 of 14 subjects (47.2 +/- 19.2). The BAL lymphocyte subsets, measured by monoclonal antibody in 8 subjects, showed a wide range of values, with individual OKT4/OKT8 ratios remaining similar at both studies. There were no correlations between changes seen in individual pulmonary function and BAL lymphocytosis. We conclude that a high intensity lymphocytic alveolitis, which persists after an acute episode of farmer's lung, does not predict the outcome of the disease.