CHEST Guidelines-Rebuttal-From-Drs-Wells-and Kokosi_2017

Rebuttal-From-Drs-Wells-and Kokosi_2017_chest

Pdf Summary

The commentary on idiopathic pulmonary fibrosis (IPF) discusses the role of bronchoalveolar lavage (BAL) in its diagnostic evaluation. The primary debate centers around whether the presence or absence of BAL lymphocytosis can significantly affect the likelihood of an IPF diagnosis. Specifically, the presence of BAL lymphocytosis might suggest alternative diagnoses, like chronic hypersensitivity pneumonitis, thereby decreasing the likelihood of IPF. This situation could necessitate a surgical lung biopsy to confirm the diagnosis. The document highlights the limitations of relying solely on evidence-based medicine, emphasizing the ongoing importance of expert opinion, particularly where conclusive data is lacking.<br /><br />Drs. Wells and Kokosi argue for the utility of BAL, suggesting it provides substantial information that might support or dissuade progression to invasive diagnostic procedures like surgical lung biopsy (SLB). They stress that in the absence of BAL lymphocytosis, there might be less justification for SLB, which carries higher mortality risks, especially among those suspected of having IPF.<br /><br />Conversely, Drs. Mooney and Collard challenge the routine use of BAL due to the lack of reliable data supporting its diagnostic contribution. They highlight two scenarios: one where patients have a defined radiographic IPF pattern with a high probability of IPF, and another involving less certain cases. In both settings, they express skepticism about BAL reliably contributing to a more definitive diagnosis of IPF or other conditions.<br /><br />Overall, the experts agree that while BAL can have diagnostic relevance, especially in identifying other conditions, its use remains contentious without robust data to demonstrate its effectiveness beyond expert opinion and clinical experience. Accurate diagnosis is vital in the context of IPF, given the disease's implications and treatment risks.

Keywords

idiopathic pulmonary fibrosis

bronchoalveolar lavage

BAL lymphocytosis

diagnostic evaluation

surgical lung biopsy

chronic hypersensitivity pneumonitis

expert opinion

evidence-based medicine

radiographic IPF pattern

diagnostic relevance