Evidence map›Paper›PMID 41956555›Full record

ArticleBMJ open respiratory research2026

Association of bronchoalveolar lavage cellular analysis and radiological findings in fibrotic interstitial lung diseases.

Punchalee Kaenmuang, Joseph L Barnett, Toby M Maher, Jennifer K Quint, Alexander Adamson, Zhe Wu, David J F Smith, Bhavin Rawal, Arjun Nair, Simon L F Walsh and 13 more

Abstract read
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Article in BMJ open respiratory research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Punchalee KaenmuangMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK punchalee.k@psu.ac.th.ORCID http://orcid.org/0000-0001-7877-0468
Joseph L BarnettDepartment of Radiology, Royal Free Hospital, London, UK.
Toby M MaherKeck School of Medicine, University of Southern California, Los Angeles, California, USA.
Jennifer K QuintNational Heart and Lung Institute, Imperial College London, London, UK.
Alexander AdamsonSchool of Public Health, Imperial College London, London, UK.ORCID http://orcid.org/0000-0003-0265-5900
Zhe WuInterstitial Lung Disease Unit, Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
David J F SmithInterstitial Lung Disease Unit, Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Bhavin RawalDepartment of Radiology, Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Arjun NairDepartment of Radiology, University College Hospital, London, UK.
Simon L F WalshNational Heart and Lung Institute, Imperial College London, London, UK.
Sujal R DesaiNational Heart and Lung Institute, Imperial College London, London, UK.
Peter M GeorgeMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
Maria KokosiMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
Vasilis KouranosMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
Elisabetta A RenzoniMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
Alexandra RiceNational Heart and Lung Institute, Imperial College London, London, UK.
Andrew G NicholsonNational Heart and Lung Institute, Imperial College London, London, UK.
Felix ChuaMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
Athol U WellsMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
Philip L MolyneauxInterstitial Lung Disease Unit, Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.ORCID http://orcid.org/0000-0003-1301-8800
Anand DevarajNational Heart and Lung Institute, Imperial College London, London, UK.
R Gisli JenkinsMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.ORCID http://orcid.org/0000-0002-7929-2119
Iain D StewartMargaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.ORCID http://orcid.org/0000-0002-1340-2688

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsInflammation may play a role in driving interstitial lung diseases (ILD). Radiological ground-glass opacity (GGO) may not reliably distinguish fine intralobular fibrosis from inflammatory processes in fibrotic ILD. We therefore investigated the relationship between GGO, fibrosis and leukocytes in bronchoalveolar lavage (BAL).

methodsWe recruited patients with fibrotic ILD at a single centre between May 2014 and February 2018. The extent of GGO and fibrosis was evaluated by two radiologists. Linear regression examined the association between leucocyte numbers in BAL obtained from the right middle lobe and GGO/fibrosis extent in whole lung, adjusting for age, sex and smoking. A Z-test was used to compare the association between BAL and GGO/fibrosis.

results316 patients were included. Adjusting analyses for covariates, only BAL eosinophil and eosinophil-to-macrophage ratio were positively associated with GGO involvement (0.23 (95% CI 0.03 to 0.42) p=0.023 and 11.21 (95% CI 1.33 to 21.08) p=0.026). Lymphocyte percentages (fibrosis -0.17 vs GGO -0.02 p=0.046); neutrophil percentages (fibrosis 0.38 vs GGO 0.06 p=0.002); neutrophil-to-lymphocyte ratio (fibrosis 0.63 vs GGO -0.05 p=0.027); neutrophil-to-macrophage ratio (fibrosis 14.08 vs GGO 2.57 p=0.015) and neutrophilia (fibrosis 6.81 vs GGO -0.31 p=0.002) all demonstrated a significantly stronger association with fibrosis than GGO.

conclusionsLack of relationships between radiological GGO and BAL leucocyte counts in fibrotic lung disease indicates that GGO may not always be inflammatory in nature. Higher levels of neutrophils were associated with more extensive fibrosis.

Indexed as

Bronchoalveolar Lavage FluidLungLung Diseases, InterstitialPulmonary FibrosisAgedBronchoalveolar LavageEosinophilsFemaleHumansMaleMiddle AgedNeutrophilsTomography, X-Ray ComputedBronchoscopyImaging/CT MRI etcInterstitial Fibrosis

Identifiers

PMID41956555
PMCPMC13084991

What Socratic holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.