Introduction
The rapid outbreak of coronavirus disease 2019 (COVID-19), originating
from severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2)
infection, is a public health emergency of international concern.
Diagnosing COVID-19, treating its complications, and predicting how the
disease will progress in different patients remains a challenge. The
DRAGON project (IMI 2-call 21, #101005122) is drawing on new and
existing data and sample collection efforts to carry out a detailed
profiling of patients. In the Dragon consortium, Florence University,
Italy and Centre Hospitalier Universitarie de Liege, Belgium have
focused their research on the role of interventional pulmonology (IP)
and bronchoalveolar lavage (BAL) sample collection in COVID-19. This
document reflects the perspective of some of the Dragon research
consortium collaborators on the utility of BAL in COVID-19.
Interventional pulmonology in patients with COVID-19 is required to
manage complications (atelectasis, haemoptysis, pneumothorax, pleural
effusions, etc), and to guide airways management (airway secretion
management, intubation or tracheostomy guide). BAL in COVID-19 has been
used to obtain samples for both cytology and microbiology purposes
(detecting infections, differential diagnosis with other interstitial
lung disorders, etc). If the role of IP in treating COVID-19
complications and guiding airway management is well established, the
role of BAL in COVID-19 diagnosis and management has been questioned.
Bronchoscopy is an aerosol generating procedure, and its routinely use
in COVID-19 patients has been discouraged.1 However,
avoiding bronchoscopy in COVID-19 patients expose physicians to risks of
misdiagnosis and suboptimal treatment. BAL is a well-established
minimally invasive technique that has an important diagnostic role and
has been routinely used for decades for the diagnosis of infectious,
neoplastic and non-neoplastic diffuse lung diseases. BAL clinical role
in the diagnosis of respiratory infection is of utmost
importance.2-5 Therefore, BAL has been used in many
expert centres to manage COVID-19 and in several research protocols to
investigate COVID-19 pathogenetic mechanisms.
We aimed to review the current evidence supporting the role of BAL in
the diagnosis of COVID-19 infection, in the detection of coexisting
infections, and in the understanding of COVID-19 features and
pathogenetic mechanisms.