Side-effects and safety of BAL.

As for many clinical tools, there is at the present time no clear agreement on the appropriate clinical use of BAL. Undoubtedly, the recent and encouraging clinical experiences with BAL for diagnosis of opportunistic infections in the immunocompromised patient have encouraged a universal acceptance and interest in BAL. Because of the low morbidity of the lavage procedure and the significant yield of clinically important information, many physicians have been encouraged to perfonn a lavage during bronchoscopies undertaken for a variety of indications. This has resulted in a considerable body of experience with BAL in a number of clinical settings. For many years, one of the main obstacles for general acceptance of BAL as a clinical tool has been the vast disparity among centres worldwide regarding the technique and the processing of the BAL material. In order to address this important issue of standardization the European Society of Pneumology (SEP), in 1988, set up a Task Force on Bronchoalveolar Lavage. The first report of the group focused specifically on technical recommendations and guidelines on how to perfonn BAL and how to process BAL material and was published in 1989 in this journal [1]. This is the second joint report of the SEP Task Group on BAL and gives appropriate guidelines and information about the clinical indications and use of BAL in various diseases of the lung. The members of the Task Group have collected all relevant infonnation so far available about the clinical usefulness and indications of BAL. As a result of a critical review of the material and with the help of two consensus conferences of the group this state-of-the-art paper has been produced. It was the aim of the group to provide a short and informative report for the use of clinicians. Thus, this report is not intended as a comprehensive review of each of the topics. It provides guidelines and recommendations about the clinical value of BAL for diagnosis, for prediction of prognosis, and gives some comparative evaluation of BAL to other established investigative means. Only the pertinent literature for these issues is referenced. A small chapter deals with therapeutic applications of bronchial lavage or bronchoalveolar lavage. Because the field of BAL worldwide is so rapidly evolving and the application of BAL is so widespread, this report can only give recommendations and guidelines, and should not be regarded as an "indication book". There will be several centres where a special expertise for diagnostic applications of BAL has been accomplished which will regard our recommendations as being too restrictive; and there will be other centres also which are still in a learning and experimental stage regarding the clinical use and perfonnance of BAL. Therefore, our Task Group tried to meet the understanding and the requirements of most of the centres currently performing BAL and to give a fair balance regarding our clinical recommendations.