Clinical application of bronchoscopy and bronchoalveolar lavage in the immunocompromised host.

Pulmonary complications are the most frequent cause of morbidity and mortality in immunocompromised patients. The speed of clinical assessment and the initiation of appropriate therapy is critically related to survival. Fibreoptic bronchoscopy and bronchoalveolar lavage (BAL) had proved useful in making the diagnosis of pulmonary complications in a high proportion of immunocompromised patients, where less invasive techniques, such as blood cultures or sputum induction, have failed to establish a diagnosis. Bronchoscopy and BAL cause little discomfort and low morbidity, and should be performed as early in the disease course as possible, preferably before the onset of respiratory failure.