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Topic:Bronchoalveolar Lavage

Bronchoalveolar lavage (BAL) is a diagnostic procedure used to collect samples from the lower respiratory tract of horses. The technique involves the introduction of a sterile fluid into the bronchi and alveoli, which is then retrieved for analysis. BAL is utilized to assess the cellular and microbiological composition of the lower airways, aiding in the diagnosis of respiratory conditions such as inflammatory airway disease, recurrent airway obstruction, and infections. The procedure provides valuable insights into the type and extent of inflammation or infection present in the respiratory system. This page compiles peer-reviewed research studies and scholarly articles that explore the methodology, applications, and clinical relevance of bronchoalveolar lavage in equine respiratory health.
Investigations on the ability of clenbuterol hydrochloride to reduce clinical signs and inflammation associated with equine influenza A infection.
Equine veterinary journal    April 23, 1999   Volume 31, Issue 2 160-168 doi: 10.1111/j.2042-3306.1999.tb03810.x
Kästner SB, Haines DM, Archer J, Townsend HG.Twenty-four Quarter Horse and Quarter Horse-cross yearlings were experimentally infected with influenza A virus (Influenza A/equine/Saskatoon/90 [H3N8]) by nebulisation. In a double blind controlled trial the horses were randomly assigned to 3 groups of 8 animals. Group 1 received a placebo, (carrier syrup), Group 2 the labelled dose and Group 3 twice the labelled dose of clenbuterol hydrochloride. All treatments were given per os b.i.d. for 10 days and started on the day of infection. The horses were monitored for clinical signs of influenza infection for 14 days. Bronchoalveolar lavages were...
Alveolar clearance in horses with chronic obstructive pulmonary disease.
American journal of veterinary research    April 22, 1999   Volume 60, Issue 4 495-500 
Votion DM, Vandenput SN, Duvivier DH, Lambert P, van Erck E, Art T, Lekeux PM.To assess sensitivity of scintigraphic alveolar clearance rate as an indicator of alveolar epithelium damage in horses. Methods: 5 healthy horses (group A) and 5 with chronic obstructive pulmonary disease (COPD; group B). Methods: Horses underwent clearance rate (k [%/min]) determination. Clearance rate of group-B horses was determined after remission of the disease following 2 months at pasture (remission 1), stabling in a controlled environment (remission 2), and during crisis induced by exposure to moldy hay and straw. Methacholine challenge test was performed at each investigation period t...
Purification and biochemical characterization of pulmonary surfactant protein A of horses.
American journal of veterinary research    February 27, 1999   Volume 60, Issue 2 169-173 
Hobo S, Ogasawara Y, Kuroki Y, Akino T, Yoshihara T.To characterize surfactant protein isolated from bronchoalveolar lavage fluids of healthy horses. Methods: 10 Thoroughbreds (5 males, 5 females; 26 to 40 months old) that did not have a history or clinical signs of respiratory tract disease. Methods: Bronchoalveolar lavage fluid (BALF) was obtained and centrifuged at 33,000 X g. Lipid was removed from precipitated fractions by means of extraction with 1-butanol, and organic solvent-insoluble protein precipitates were dialyzed against Tris buffer. The suspension was centrifuged, and supernatant was placed in a mannose-Sepharose affinity column,...
Variations in systemic and pulmonary endothelin-1 in horses with recurrent airway obstruction (heaves).
Pulmonary pharmacology & therapeutics    January 27, 1999   Volume 11, Issue 2-3 231-235 doi: 10.1006/pupt.1998.0144
Benamou AE, Art T, Marlin DJ, Roberts CA, Lekeux P.Recurrent airway obstruction (RAO) is an asthma-like condition of the horse that represents a major cause of morbidity and loss of performance. The exact pathogenesis of asthma in man is unclear but the role of endothelin (ET) is currently under investigation, thus sparking interest in the bronchoconstrictive and vasoconstrictive properties of endothelin in the equine-specific disease entity. In this study, we investigated the levels of ET-1 in systemic blood, as well as in bronchoalveolar lavage (BAL) from horses with RAO. We also studied how these values might correlate with those of lung fu...
Effect of timing and route of administration of furosemide on pulmonary hemorrhage and pulmonary arterial pressure in exercising thoroughbred racehorses.
American journal of veterinary research    January 26, 1999   Volume 60, Issue 1 22-28 
Lester G, Clark C, Rice B, Steible-Hartless C, Vetro-Widenhouse T.To examine effect of pre-exercise administration of furosemide (FUR) on mean pulmonary arterial pressure (PAP) during work and RBC concentration in bronchoalveolar lavage fluid (BALF) collected 40 minutes after exercise. Methods: 10 adult Thoroughbreds. Methods: A modified 10 X 10 crossover design comprising 10 horses during 10 weeks was used. Each horse received each of 5 treatments twice. Treatment structure included a control plus a 2 X 2 factorial and consisted of the following: A, control; B, FUR, 250 mg, IV, 30 minutes before exercise; C, FUR, 250 mg, IV, 240 minutes before exercise; D, ...
Flow cytometric determination of oxidative burst activity of equine peripheral blood and bronchoalveolar lavage-derived leucocytes.
Veterinary journal (London, England : 1997)    November 7, 1998   Volume 156, Issue 2 117-126 doi: 10.1016/s1090-0233(05)80037-1
Raidal SL, Bailey GD, Love DN.Flow cytometric techniques were developed for the evaluation of oxidative burst activity in equine peripheral blood neutrophils and lymphocytes, as well as bronchoalveolar lavage derived pulmonary alveolar macrophages and lymphocytes. The oxidation of dichlorofluorescin was measured by the increased fluorescence of cells stimulated with phorbol myristate acetate or a variety of other stimulants. Flow cytometry was a suitable method for the evaluation of the intracellular oxidation in all cell populations evaluated. Analysis was rapid and cell separation before analysis was not required. Hetero...
The flow cytometric evaluation of phagocytosis by equine peripheral blood neutrophils and pulmonary alveolar macrophages.
Veterinary journal (London, England : 1997)    November 7, 1998   Volume 156, Issue 2 107-116 doi: 10.1016/s1090-0233(05)80036-x
Raidal SL, Bailey GD, Love DN.Flow cytometry was used to assess the phagocytosis of fluorescent-labelled bacteria by equine peripheral blood neutrophils and pulmonary alveolar macrophages. Cell populations were prepared from venous blood following ammonium chloride lysis and from washed bronchoalveolar lavage derived samples. Discrete clusters of cells, corresponding to different leucocyte groups, were readily identified on the basis of differing light scattering properties and could thus be discriminated, negating the need for prior cell separation. Cells able to associate with fluorescent-labelled bacteria (by attachment...
Cytologic evaluation of bronchoalveolar lavage fluid from horses with recurrent airway obstruction after aerosol and parenteral administration of beclomethasone dipropionate and dexamethasone, respectively.
American journal of veterinary research    August 26, 1998   Volume 59, Issue 8 1033-1038 
Rush BR, Flaminio MJ, Matson CJ, Hakala JE, Shuman W.To determine cytologic changes in horses with recurrent airway obstruction (heaves) after administration of aerosolized beclomethasone dipropionate and dexamethasone parenterally. Methods: 6 horses with inducible and reversible heaves. Methods: Episodes of heaves were induced by exposure to moldy hay and straw for 7 days. Horses were assigned to treatment groups (aerosolized beclomethasone, parenterally administered dexamethasone, aerosolized propellant), and pulmonary inflammation was evaluated by serial cytologic examination of bronchoalveolar lavage (BAL) fluid samples obtained on days 0, 7...
Quantification of exercise-induced pulmonary haemorrhage with bronchoalveolar lavage.
Equine veterinary journal    August 15, 1998   Volume 30, Issue 4 284-288 doi: 10.1111/j.2042-3306.1998.tb04098.x
Meyer TS, Fedde MR, Gaughan EM, Langsetmo I, Erickson HH.Exercise-induced pulmonary haemorrhage (EIPH) causes serious economic losses in the horse racing industry. Endoscopic examination indicates that 40-90% of horses exhibit EIPH following sprint exercise, but the limitations of the endoscope prevent diagnosis in many horses. Bronchoalveolar lavage (BAL) was utilised to detect red blood cells (RBCs) in the terminal airways in 6 horses. Two lavages were performed at weekly intervals prior to exercise, one within 90 min after exercise, and 5 at weekly intervals after exercise. The horses were exercised strenuously at 12.5-14.6 m/s on a treadmill (3 ...
Scintigraphical evaluation of alveolar clearance in horses.
Veterinary journal (London, England : 1997)    August 6, 1998   Volume 156, Issue 1 51-58 doi: 10.1016/s1090-0233(98)80061-0
Votion D, Vandenput S, Duvivier DH, Lambert P, Art T, Lekeux P.This study proposed a standardized method for measuring alveolar epithelium membrane permeability in the horse. The normal rate of clearance (%.min-1) from lung into blood of nebulized 99mTc-DTPA has been established for healthy horses (Group A) compared with values obtained with horses suffering from chronic obstructive pulmonary disease (COPD; Group B). The 99mTc-DTPA clearance was measured in the caudoventral (R1) and in the half caudal (R2) parts of the left lung during different time intervals. The two regions aimed to define the influence of the airways on measured clearance (R2 containe...
CD4+ and CD8+ T-lymphocytopenia in a filly with Pneumocystis carinii pneumonia.
Australian veterinary journal    July 23, 1998   Volume 76, Issue 6 399-402 doi: 10.1111/j.1751-0813.1998.tb12387.x
Flaminio MJ, Rush BR, Cox JH, Moore WE.Decreased proportion of CD4+ and CD8+ T lymphocytes in peripheral blood likely contributed to susceptibility to Pneumocystis carinii in a foal. Cytological evaluation of bronchoalveolar lavage was required for identification of the pathogen and serial flow-cytometric analysis of peripheral blood lymphocytes documented transient low expression of CD4+ and CD8+ T lymphocytes. Although immunodeficiency is uncommon, it must be included in the differential diagnosis for patients suffering from chronic or opportunistic infections and may provide an indication for immunostimulant therapy.
Pulmonary eosinophilia associated with increased airway responsiveness in young racing horses.
Journal of veterinary internal medicine    May 22, 1998   Volume 12, Issue 3 163-170 doi: 10.1111/j.1939-1676.1998.tb02112.x
Hare JE, Viel L.Horses are known to acquire small airway disease (SAD), an allergen-induced naturally occurring syndrome of reversible obstructive lung disease accompanied by airway hyperresponsiveness and increased inflammatory cell numbers on bronchoalveolar lavage (BAL). This disorder has received scant attention in young racehorses. The purpose of the present report was to examine the effect of BAL eosinophilia in young racehorses on clinical examination, BAL, hematology, airway responsiveness, and on pulmonary function at rest and after a standardized exercise challenge. Five (3 males, 2 females; age 2.6...
Evaluation of an in vitro degranulation challenge procedure for equine pulmonary mast cells. Hare JE, Viel L, Conlon PD, Marshall JS.Pulmonary mast cells (PMC) are important components of the inflammatory process in equine allergic lung diseases such as heaves. Very little, however, is known of the degranulation kinetics of these cells and thus, their pathophysiologic role remains largely speculative. The purpose of this study was to develop a repeatable protocol for in vitro equine PMC degranulation. Five mature horses (sex: 2 M, 3 F; age: 8.8 +/- 6.5 y), historically free of pulmonary disease and normal on clinical respiratory examination, arterial blood gas analysis, pulmonary mechanics testing and histamine inhalation c...
Association between bronchoalveolar lavage cytologic features and airway reactivity in horses with a history of exercise intolerance.
American journal of veterinary research    March 11, 1998   Volume 59, Issue 2 176-181 
Hoffman AM, Mazan MR, Ellenberg S.To correlate indices of airway reactivity to bronchoalveolar lavage (BAL) fluid cytologic features in horses with a recent decline in exercise tolerance. Methods: 20 actively working horses from 2 to 24 years old. Methods: Bronchoalveolar lavage fluid samples were obtained and analyzed. Forced oscillatory mechanics (1-7 Hz) technique was used for measurements of total respiratory system resistance (RRS), compliance (CRS), and resonant frequency (fres). Changes in RRS (1 Hz) during histamine challenge were used to generate histamine dose-response curves, from which the provocative concentration...
Quantification of antigen-specific antibody concentrations in tracheal lavage fluid of horses with summer pasture-associated obstructive pulmonary disease.
American journal of veterinary research    December 24, 1997   Volume 58, Issue 12 1408-1411 
Seahorn TL, Beadle RE, McGorum BC, Marley CL.To determine whether horses with summer pasture-associated obstructive pulmonary disease (SPAOPD) have increased concentrations of antigen-specific IgG and IgE in tracheal lavage fluid, compared with values in clinically normal horses. Methods: 8 horses (6 females, 2 geldings; 6 Quarter Horses, 2 Appaloosas), 14 to 23 years old and with previous diagnosis of SPAOPD, served as the principal group; 8 horses (2 females, 6 geldings; 1 Quarter Horse, 7 Thoroughbreds), 6 to 9 years old, with no evidence of respiratory tract disease, served as the control group. Methods: Data were collected twice dur...
Small airway disease as a vanguard for chronic obstructive pulmonary disease.
The Veterinary clinics of North America. Equine practice    November 22, 1997   Volume 13, Issue 3 549-560 doi: 10.1016/s0749-0739(17)30230-4
Viel L.Equine allergic small airway disease is a highly prevalent respiratory condition among the stabled horse population. With the assistance of new diagnostic tools such as bronchoalveolar lavage, the condition can be recognized in young performing horses. The pathophysiological and clinical features resemble an earlier stage of chronic obstructive pulmonary disease as determined by the appearance of specific inflammatory cells. Although environmental management is paramount in controlling the disease, proper selective therapeutic regimens are as important to reduce the concurrent inflammation and...
Hyaluronate concentration in tracheal lavage fluid from clinically normal horses and horses with chronic obstructive pulmonary disease.
American journal of veterinary research    July 1, 1997   Volume 58, Issue 7 729-732 
Tulamo RM, Maisi P.To establish concentration of hyaluronate (HA) in tracheal lavage fluid from healthy horses and horses with chronic obstructive pulmonary disease (COPD). ANIMALS AND SAMPLES: Tracheal lavage fluid samples (n = 42) from 18 horses, 11 with COPD, and 7 control horses. Methods: Clinical examination of the respiratory tract, tracheal lavage, and blood sample collection were performed on horses without clinical signs of respiratory tract disease and horses with clinical signs of COPD. In some horses, 1 to 5 repeated examinations were performed at 1-week intervals. Tracheal lavage fluid samples were ...
Immunophenotypic analysis of foal bronchoalveolar lavage lymphocytes.
Veterinary microbiology    June 16, 1997   Volume 56, Issue 3-4 237-246 doi: 10.1016/s0378-1135(97)00092-8
Balson GA, Smith GD, Yager JA.The purpose of this study was to define the normal immunophenotype of equine lymphocytes present within the pulmonary air spaces, and to determine if this changes as foals age from one to ten weeks. Six pairs of mares and foals underwent sequential bronchoalveolar lavage (BAL) between 1 and 10 weeks of age. Data were grouped according to foal age (1, 1-3, 3-6, or 6-10 weeks of age) and were compared to adult control values obtained from the mares. BAL cells were harvested and stained with antibodies to the equine homologues of CD5, CD4, CD8, CD44, MHC I, MHC II and to equine IgG. Data, includi...
Effect of transportation on the composition of bronchoalveolar lavage fluid obtained from horses.
American journal of veterinary research    May 1, 1997   Volume 58, Issue 5 531-534 
Hobo S, Oikawa M, Kuwano A, Yoshida K, Yoshihara T.To study the effects of extended transportation on the composition of bronchoalveolar lavage fluid (BALF) obtained from horses. Methods: 30 horses (14 males, 16 females: 25 Thoroughbreds and 5 Thoroughbred-Arabian cross-breds; 27 to 30 months old) without a history or clinical signs of respiratory tract disease. Bronchoalveolar lavage was performed on nontransported control horses (groups 1 and 2) and transported horses (group 3). Methods: 20 horses were used to determine the effect of 41 hours of transportation on the composition of BALF (group 3). Bronchoalveolar lavage fluid was analyzed fo...
Phenotypic characterization of lymphocyte subpopulations in horses affected with chronic obstructive pulmonary disease and in normal controls.
Veterinary pathology    March 1, 1997   Volume 34, Issue 2 108-116 doi: 10.1177/030098589703400203
Watson JL, Stott JL, Blanchard MT, Lavoie JP, Wilson WD, Gershwin LJ, Wilson DW.The alterations in lymphocyte subsets in chronic obstructive pulmonary disease (COPD) in the horse were investigated by using monoclonal antibodies to identify CD3+, CD4+, CD8+, and surface immunoglobulin positive (sIg+) lymphocytes in peripheral blood, bronchoalveolar lavage fluid (BALF), and pulmonary biopsy frozen tissue sections. COPD-affected horses (n = 5) and normal controls (n = 5) were sampled prestabling and 14 days poststabling, at which time the COPD-affected horses wee exhibiting clinical signs of COPD. The peripheral blood absolute CD4+ lymphocyte count was significantly elevated...
Inflammatory markers in bronchoalveolar lavage fluid of standardbred racehorses with inflammatory airway disease: response to interferon-alpha.
Equine veterinary journal    March 1, 1997   Volume 29, Issue 2 142-147 doi: 10.1111/j.2042-3306.1997.tb01656.x
Moore BR, Krakowka S, Mcvey DS, Cummins JM, Robertson JT.Protein and eicosanoid concentrations and procoagulant activity were determined in bronchoalveolar lavage fluid (BALF) from 32 Standardbred racehorses with inflammatory airway disease (IAD) and 6 control horses. Total protein, albumin and immunoglobulin G (IgG) concentrations were high (P < 0.05) in the BALF from horses with IAD, a finding consistent with exudation of plasma protein into the airway. Immunoglobulin A (IgA) concentrations also were increased (P < 0.05) which may signify local immunoglobulin production. Difference was not detected in prostaglandin E2 and 6-ketoprostaglandin...
Effect of treatment with erythromycin on bronchoalveolar lavage fluid cell populations in foals.
American journal of veterinary research    January 1, 1997   Volume 58, Issue 1 56-61 
Lakritz J, Wilson WD, Watson JL, Hyde DM, Mihalyi J, Plopper CG.To determine whether oral administration of erythromycin alters the inflammatory response to bronchoalveolar lavage (BAL) in young horses. Methods: 12 healthy, unweaned, mixed-breed foals of either sex, between 2 and 4 months old. Methods: BAL was performed; 250 ml of phosphate-buffered saline solution (300 mOsm, pH 7.4) was administered in 50-ml aliquots. Foals were carefully monitored for 4 days, then erythromycin base (25 mg/kg of body weight, PO, q 12 h) was given to foals of the treated group. After 4 days, foals were reanesthetized, and the same lung was relavaged. Cytologic examination ...
Lower respiratory tract disease.
The Veterinary clinics of North America. Equine practice    December 1, 1996   Volume 12, Issue 3 457-472 doi: 10.1016/s0749-0739(17)30267-5
Moore BR.Lower respiratory tract disease is an important source of poor performance and exercise intolerance in racehorses and middle-aged sport horses. Horses that perform high-intensity exercise are predisposed to development of infectious and noninfectious respiratory disease. Diagnostic aids for investigation of lower respiratory tract disease include thorough thoracic auscultation with rebreathing, endoscopic examination, bronchoalveolar lavage (BAL), and thoracic radiographic examination. The therapeutic approach for horses with lower respiratory tract diseases often can be directed by cytologic ...
Diagnostic approach to exercise intolerance in racehorses.
The Veterinary clinics of North America. Equine practice    December 1, 1996   Volume 12, Issue 3 555-564 doi: 10.1016/s0749-0739(17)30272-9
Lilich JD, Gaughan EM.The diagnostic approach to the exercise intolerant racehorse depends on sound, fundamental steps to allow complete examination of the entire horse in a logical, time-efficient fashion. Availability of referral diagnostic modalities should not overshadow the need for collecting a clinical history or performing a complete physical examination. The diagnostic approach to exercise intolerance can be divided into a few basic steps. The first step, conducted without the horse, is a thorough discussion about the horse with the trainer and/or owner. Many clinical histories are complex and therefore fo...
Effects of ozone and airway inflammation on glutathione status and iron homeostasis in the lungs of horses.
American journal of veterinary research    September 1, 1996   Volume 57, Issue 9 1359-1363 
Mills PC, Roberts CA, Smith NC.To investigate the effects of ozone and airway inflammation on indices of oxidant injury in horses. Methods: 5 clinically normal horses and 25 horses referred for poor performance. Methods: Blood, tracheal wash, and bronchoalveolar lavage fluid samples were collected before and after ozone exposure (n = 5) or from clinical cases (n = 25), and were analyzed for reduced glutathione (GSH), glutathione disulfide (GSSG), and free and total iron (Fe) values. A scoring system (0 to 5) was used to assess airway inflammation on the basis of clinical signs and cytologic analysis of the tracheal wash and...
Residence and recruitment of leucocytes to the equine lung after EHV-1 infection.
Veterinary immunology and immunopathology    June 15, 1996   Volume 52, Issue 1-2 15-26 doi: 10.1016/0165-2427(95)05533-9
Kydd JH, Hannant D, Mumford JA.This study characterised bronchoalveolar leucocytes collected by lavage from five susceptible and two immune ponies before and after nebulised aerosol infection with equid herpesvirus-1 (EHV-1). Leucocyte counts and lymphocyte phenotypic analyses were performed using either differential staining or an indirect immunofluorescence assay with monoclonal antibodies specific for equine (Eq) CD4, CD5, CD8 and B lymphocytes. After EHV-1 infection, significant changes developed: a transient neutrophilia occurred on Day 2, coincident with a reduction in macrophage numbers and an EqCD5+, EqCD4+ and EqCD...
Quantitative characterization of lymphocyte populations in bronchoalveolar lavage fluid and peripheral blood of normal adult Arabian horses.
Veterinary immunology and immunopathology    May 1, 1996   Volume 51, Issue 1-2 29-37 doi: 10.1016/0165-2427(95)05510-x
Hines MT, Palmer GH, Byrne KM, Brassfield AL, McGuire TC.Bronchoalveolar lavage fluid (BALF) and peripheral blood were obtained from each of 17 adult Arabian mares and absolute numbers and relative lymphocyte proportions were determined for total T lymphocytes, using CD2 as a marker, CD4 + T lymphocytes, CD8 + T lymphocytes, CD5 + lymphocytes, and sIgM + B lymphocytes. The marked variation in BALF cell recovery resulted in wide variation in absolute values for each lymphocyte subset. The relative proportions of gated BALF lymphocytes were much less variable and provided a basis for comparison of lymphocyte subsets between the BALF and peripheral blo...
Obstructive pulmonary disease in 18 horses at summer pasture.
The Veterinary record    January 27, 1996   Volume 138, Issue 4 89-91 doi: 10.1136/vr.138.4.89
Mair TS.The clinical features of 18 cases of summer pasture associated obstructive pulmonary disease were reviewed. The horses had signs of obstructive pulmonary disease (expiratory dyspnoea, wheezing and crackling lung sounds and coughing) during the spring, summer or autumn while they were kept permanently at grass with no access to hay or straw, for at least two consecutive years. In nine cases there was a seasonal incidence with the disease occurring during April and May. Eleven of the horses were affected by bouts of severe dyspnoea. Eleven of the horses also suffered from chronic obstructive pul...
Changes in airway inflammatory cell populations in standardbred racehorses after interferon-alpha administration.
Veterinary immunology and immunopathology    January 1, 1996   Volume 49, Issue 4 347-358 doi: 10.1016/0165-2427(95)05480-4
Moore BR, Krakowka S, Cummins JM, Robertson JT.Natural human interferon-alpha (nHuIFN alpha) was administered to actively training Standardbred racehorses with inflammatory airway disease (IAD). Inflammatory airway disease was characterized by poor exercise performance and inflammation and exudate in the upper and lower airway. Placebo, 50, 150, or 450 units(U) of nHuIFN alpha was administered orally for 5 consecutive days to eight horses per treatment group in a double-blind, randomized block design. Response to nHuIFN alpha was monitored by semiquantitative endoscopic examination score and cytologic examination of bronchoalveolar lavage ...
Equine pulmonary disease: a case control study of 300 referred cases. Part 3: Ancillary diagnostic findings.
Equine veterinary journal    November 1, 1995   Volume 27, Issue 6 428-435 doi: 10.1111/j.2042-3306.1995.tb04423.x
Dixon PM, Railton DI, McGorum BC.The majority of 270 adult horses with chronic pulmonary diseases had excessive volumes of respiratory secretions (RS) present in their trachea, elevated tracheal RS neutrophil ratios and lowered arterial oxygen partial pressures. Some control horses, had inexplicably elevated trachael RS neutrophil ratios. Only the chronic obstructive pulmonary disease (COPD) affected group had significantly elevated bronchoalveolar lavage fluid (BALF) neutrophil ratios. Maximal intrapleural pressure changes (max dPpl) were raised in 48% of COPD cases and rarely with other pulmonary disorders. Arterial pH or c...