Alveolar lymphocytes in the follow-up of sarcoidosis

Bronchoalveolar lavage (BAL) was performed in a group of 25 patients with pulmonary sarcoidosis in order to monitor variations in alveolar lymphocytes (AL) in comparison to the clinical evolution of the disease. Two BAL were performed in each patient, the second 6-12 months after the first (8.9 +/- 3, M +/- SD). Twelve patients were classified as improved and 13 as unimproved on the basis of a score of changes in the clinical picture, x-ray, respiratory function, immunological and biochemical tests. There was a significant decrease (p less than 0.001) of the percentage of AL in 66% of cases in the improved group, but not in the unimproved group, where, on the contrary, it was possible to observe an increase in the percentage of AL in 46% of these cases (n.s.). In 9 of 11 patients followed for 1-5 years with at least 3 BAL, AL behaviour correlated with clinical evolution. On the basis of the parameters studied, it was possible to show a correlation between lymphocytes, alveolitis and clinical evolution, especially in patients with an improved course. While a single BAL does not seem to be sufficient to show the course of the disease, repeated long-term washings allow a more accurate staging of sarcoidosis and can give early warning of relapses even when the conventional parameters (clinical, radiological and functional) are unchanged. Our aim was to look for a simpler parameter, which could be used routinely by even unspecialized laboratories, who are not able to type lymphocytes.