Bronchoscopy and BAL Procedures
Twenty-two children with therapy-resistant, inadequately-controlled
asthma had clinically-indicated bronchoscopy with bronchoalveolar lavage
(BAL) and assessment of air space and blood inflammatory markers two
weeks following HHe-3 MRI. Samples were shared between the clinical and
research laboratories under protocols approved by the University of
Virginia Institutional Review Board (IRB # 17555, IRB # 19180, and IRB
# 10905). A detailed description of the clinical pathway and methods
for bronchoscopy and BAL has been published previously19.
To compare granulocyte constituents in BAL from lung segments with and
without visible ventilation defects, 13 children underwent MR
image-guided BAL in bronchial segments to lobes with and without visible
ventilation defects. The images were reviewed by a pediatric radiologist
(TAA) in advance, lobes with and without ventilation defects were
identified for BAL in the main bronchial segments or sub-segments
accordingly. Fresh BAL was submitted to the cytopathology laboratory and
examined for total and differential cell count using manual procedures.
Paired BAL aliquots were labeled 1 and 2 for cytospin preparation of
smears for differential cell counts, done in triplicate, by a
cytopathologist blinded to the ventilation status of the segment from
which the sample was obtained. Safety of the bronchoscopy procedures has
been reported previously with no unexpected major adverse events19, 22.