Harm From Spirometry?

features specific for UIP such as a patchwork pattern of interstitial fibrosis, fibroblastic foci, and honeycomb change2,3 are readily recognizable in many TBB specimens.3 We agree that in these small specimens one may not identify discordant pathology. However, since the prognosis associated with “discordant” or “concordant” UIP is the same, recognizing the UIP findings will dictate the ultimate prognosis.4 We believe that these finding are quite important and should be considered as a step forward, not backward as suggested by Mukherjee and Spiteri. Unfortunately, it has become widely accepted, despite a lack of convincing evidence, that TBBs are not useful in diagnosing idiopathic interstitial pneumonias. However, if in the future TBBs are proven to be useful in diagnosing UIP from a pool of patients with diverse diffuse lung diseases, many unnecessary surgical lung biopsy procedures, with the associated morbidity, mortality, and cost, could be prevented.5 Our study plants the seeds for what could turn out to be a very important step forward in the field.