The role of whole lung lavage in pneumoconiosis patients with pulmonary diffusion limitation.

BACKGROUND: Pneumoconiosis, an occupational lung disease caused by the inhalation of mineral dust, leads to progressive pulmonary fibrosis and impaired gas exchange. A reduced diffusing capacity for carbon monoxide (DLCO) serves as an independent prognostic marker. Although whole lung lavage (WLL) is employed clinically to remove retained dust, its efficacy in ameliorating diffusion dysfunction remains controversial. OBJECTIVES: This study aimed to evaluate the impact of WLL on pulmonary function-specifically diffusion capacity-in patients with pneumoconiosis presenting with a baseline DLCO of less than 80% of the predicted value. METHODS: This single-center study analyzed a subgroup of 27 patients (14.7%) with a pre-operative DLCO <80% predicted, drawn from a larger cohort of 184 pneumoconiosis patients undergoing WLL. Pulmonary function tests (DLCO, FVC, FEV1, and FEV1/FVC ratio) and St. George's Respiratory Questionnaire (SGRQ) scores were evaluated at baseline, 1 month, and 3 months post-WLL. Changes in parameters were assessed using paired t-tests. RESULTS: The analyzed cohort (n = 27; 24 males; mean age 49.0 ± 7.0 years) demonstrated a statistically significant improvement in DLCO % predicted at 1 month post-WLL compared to baseline (70.8 ± 8.1% vs. 74.1 ± 10.8%, p = 0.031). At 3 months, the improvement in DLCO % predicted (73.6 ± 12.1%) was no longer statistically significant relative to baseline (p = 0.074). Furthermore, no significant temporal changes were observed in FVC % predicted, FEV1% predicted, the FEV1/FVC ratio, or SGRQ scores across the follow-up periods. CONCLUSION: WLL yields a transient improvement in pulmonary diffusion capacity at 1 month in pneumoconiosis patients with pre-existing diffusion dysfunction; however, this benefit is not sustained at 3 months. Furthermore, the procedure does not significantly alter ventilatory function or health-related quality of life within this timeframe.