Bronchoalveolar Lavage in Subjects Exposed to Occupational Dusts

"INTRODCJCTIONAlveolar macrophages are free lung cells located on the surface of small airways and alveoli. These phagocytes play an important role in the protection of the lung against airborne bacteria and particles.1 However, hyperactivation of pulmonary phagocytes can lead to excessive secretion of enzymes and reactive oxygen species which could result in lung injury, emphysema, or fibrosis.2,3 Analysis of bronchoalveolar lavage effluents for cell types and cellular activity has yielded information concerning the etiology of various pneumoconioses. For example, emphysema associated with inhalation of coal dust or cigarette smoke has been related to enhanced secretion of reactive oxygen species from alveolar macrophages.4-7 In contrast, hypoactivation of alveolar macrophages has been associated with inhalation of diesel particulates"" and has been related to increased susceptibility to pulmonary infection. s Inhalation of cotton dust has been associated with dramatic increases in lavagable polymorphonuclear leukocytes9 while pulmonary sarcoidosis and silicosis have been related with high numbers of lymphocytes in lavage effluentsl0,11The objective of the present study was to obtain lavage effluents from 8 control subjects, 8 healthy power plant workers exposed to fly ash, 1 healthy coal miner, and 1 rock driller with acute silicosis. These effluents were analyzed for total numbers of alveolar macrophages, lymphocytes and neutrophils and for secretory activity of alveolar macrophages. Data were then analyzed to determine what response patterns were characteristic for given dust exposures.METHODSSelection of SubjectsThe 8 control subjectS were all adult males from the area of Morgantown, WV. Two subjects among the controls had smoked cigarettes for approximately three pack-years and had stopped more than ten years ago. The 8 power plant :workers were all healthy adult male employees of a power facility in Hatfield, PA, approximately thirty miles from Morgantown. One of the power plant personnel was a comparable ex-smoker. The remaining subjects were all lifelong non-smokers. The coal miner was a healthy non-smoking male from Morgantown, WV. The rock driller was a patient under treatment with corticosteroids for acute silicosis. He had shown considerable clinical improvement with this treatment but still manifested significant radiologic and pulmonary functional abnonnalities at the time of lavage. The mean age of the 8 control subjects was 36 years (range: 31 to 49 years); the mean age of the remaining subjects studied was 38 years (range: 29 to 53 years)."