Mucociliary clearance in patients with immunoglobulin deficiency

Tracheobronchial mucociliary clearance was studied in six patients with immunoglobulin deficiency. They inhaled a test aerosol of 6 microns teflon particles tagged with 99mTc, after which external measurements of the retention of test particles in the lungs were made during 2 h. Four younger patients with common variable immunodeficiency and severe symptoms of airway infections all had a markedly slow clearance. In one of these cases clearance was measured again after 6 months of adequate medical treatment and was found much improved. Two older patients with less severe immunoglobulin deficiency (one with selective IgA deficiency and one with transient hypogammaglobulinemia), and with a history of less severe airway infections, had normal clearance. The results indicate that chronic infection of the airways, if severe enough, will damage the mucociliary transport system, but that this damage is not necessarily irreversible. Ciliary ultrastructure was investigated by electron microscopy in two of the younger patients with slow clearance, and was found to be normal.