Does bronchoalveolar lavage lymphocytosis predict prognosis in fibrotic hypersensitivity pneumonitis, and is this relationship influenced by low-dose immunomodulatory therapy at the time of BAL? - Scorecard - MDSpire

Can Lymphocytosis Detected in Bronchoalveolar Lavage Serve as a Prognostic Indicator in Fibrotic Hypersensitivity Pneumonitis, and Does Low-Dose Immunomodulatory Therapy Affect This Correlation?

  • By

  • Punchalee Kaenmuang

  • Fiammetta Danzo

  • Simon Bax

  • Richard J. Hewitt

  • Maria Kokosi

  • Vasileios Kouranos

  • Felix Chua

  • Peter M. George

  • Gisli Jenkins

  • Athol U. Wells

  • Carmel J. W. Stock

  • Piersante Sestini

  • Elisabetta A. Renzoni

  • July 21, 2026

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Clinical Scorecard: Can Lymphocytosis Detected in Bronchoalveolar Lavage Serve as a Prognostic Indicator in Fibrotic Hypersensitivity Pneumonitis, and Does Low-Dose Immunomodulatory Therapy Affect This Correlation?

At a Glance

CategoryDetail
ConditionFibrotic Hypersensitivity Pneumonitis (fHP)
Key MechanismsBronchoalveolar lavage (BAL) lymphocytosis associated with disease severity and survival outcomes.
Target PopulationPatients with fibrotic hypersensitivity pneumonitis undergoing BAL.
Care SettingInterstitial Lung Disease (ILD) specialist centers.

Key Highlights

  • Higher BAL lymphocyte percentages correlate with better survival outcomes.
  • No significant interaction between treatment status and BAL lymphocyte levels.
  • BAL lymphocytosis predicts lower mortality in both treated and untreated patients.
  • Mean age of patients was 63 years, with 43% male and 37% ever-smokers.
  • Study analyzed 247 fHP patients, including 85 on immunomodulatory therapy.

Guideline-Based Recommendations

Diagnosis

  • Diagnosis of fHP made via multidisciplinary discussion and imaging findings.

Management

  • Immunomodulatory treatment may be tapered to the lowest tolerated level.

Monitoring & Follow-up

  • Monitor lung function changes and survival outcomes post-BAL.

Risks

  • Potential for altered BAL lymphocyte levels due to immunomodulatory therapy.

Patient & Prescribing Data

Patients with fibrotic hypersensitivity pneumonitis undergoing bronchoalveolar lavage.

Immunomodulatory therapy does not significantly alter the prognostic value of BAL lymphocytosis.

Clinical Best Practices

  • Perform BAL for diagnostic purposes irrespective of immunomodulatory treatment status.
  • Consider BAL lymphocyte percentage as a prognostic indicator in fHP.

Related Resources & Content

Original Source(s)

Does bronchoalveolar lavage lymphocytosis predict prognosis in fibrotic hypersensitivity pneumonitis, and is this relationship influenced by low-dose immunomodulatory therapy at the time of BAL?

  • by Punchalee Kaenmuang, Fiammetta Danzo, Simon Bax, Richard J. Hewitt, Maria Kokosi, Vasileios Kouranos, Felix Chua, Peter M. George, Gisli Jenkins, Athol U. Wells, Carmel J. W. Stock, Piersante Sestini, Elisabetta A. Renzoni

  • July 21, 2026

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