Lower Respiratory Tract Inflammation in Chronic Bronchitis

Evaluation by Bronchoalveolar Lavage and Changes Associated With Treatment With Immucytal, a Biological Response Modifier

¹ From the Department of Pneumology, S. Andrea Hospital, La Spezia, Italy
² From the Department of Pneumology, Sondalo Hospital (Sondrio), Italy
³ From the Institute of Respiratory Disorders, University of Parma, Italy
⁴ From the Department of Pneumology, G. Gaslini Institute, Genova, Italy
⁵ From the Department of Pneumology, Busto A. Hospital (Varese), Italy

Chronic bronchitis (CB) is characterized by inflammatory changes in the bronchial tissue and by recurrent bronchitis exacerbations. In addition, defective systemic and local immune mechanisms have been demonstrated and biologic response modifiers (BRMs) have been recently introduced for clinical use in patients with CB. We studied 24 patients with CB by bronchoalveolar lavage (BAL), before and after a 4-week treatment protocol with inhaled Immucytal (Pierre-Fabre Pharma Srl, Milan, Italy), a BRM composed of bacterial ribosomal fractions and membrane proteoglycanes. Compared with normal controls (NC), before treatment BAL in patients with CB contained increased proportions of neutrophils (NC, 0.8±0.2 percent; CB, 3±1 percent), of eosinophils (NC, 0.1±0.02 percent; CB, 0.6±0.2 percent); and of lymphocytes (NC, 6±1 percent; CB, 13±2 percent; p<0.01 each comparison) with higher percentages of CD3⁺ and CD8⁺ lymphocytes (p<0.01 each comparison). In BAL from patients with CB there were also higher levels of albumin and of the ratio IgG/albumin (p<0.01 and p<0.05, respectively, compared with NC). After Immucytal treatment, the proportions of lymphocytes in BAL in patients with CB were decreased (13±2 percent before, 6±1 percent after; p<0.01). In addition, the posttreatment BAL samples contained significantly fewer neutrophils per milliliter of BAL (3.7±0.8x10³ neutrophils per milliliter of BAL before, 1.5±0.5x10³ neutrophils per milliliter after; p<0.05). No differences were seen for the proportions of lymphocyte subpopulations and for the protein levels between the BAL obtained before and after Immucytal treatment. These data demonstrate the presence of a lower respiratory tract inflammation in patients with CB and suggest that treatment of patients with CB with a BRM may change the proportions of inflammatory cells present in BAL.

Key Words: bacterial extracts • biological response modifiers • bronchoalveolar lavage • chronic bronchitis

Submitted on August 12, 1993
Accepted on January 21, 1994

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