Bronchoalveolar Lavage in Liquid Paraffin Pneumonitis: Discussion (5)
Fibrosis of the intersti-tium is usually associated with the paraffin-laden AM on the lung biopsy of patients with liquid paraffin pneumonitis. Since neutrophils may induce a lung cell injury through their secreted proteases and oxygen radicals, it could be speculated that the neutrophil alveolitis seen in our patients may control the development of interstitial fibrosis present at late stages of liquid paraffin pneumonitis. No correlation was found between BALF cell, phospholipid or protein changes, or between BALF changes and hypoxia, but such relations could not be excluded because of the small study group.
These seven cases of liquid paraffin pneumonitis seen in our department since 1981 show that the disease still occurs although the risk of chronic aspiration of mineral oil is known. This may be explained in France because this laxative is purchased without medical prescription. In Sweden, 12,000 L of liquid paraffin were sold in the pharmacies in 1981. In the United States, the Food and Drug Administration advised in 1975 against the use of mineral oils for persons at risk for inhalation such as young children, bedridden or aged patients, persons with difficulty in swallowing, but listed mineral oils among the safe and effective laxatives. buy flovent inhaler
In conclusion, liquid paraffin pneumonitis must be clinically suspected on the basis of several facts as follow: chronic pneumonitis of the lower or middle lobes with crackles; known intake of liquid paraffin; and a potential risk for inhalation. In this context, the histochemical and biochemical analysis of the BALF, demonstrating the presence of liquid paraffin, is very useful for the diagnosis and avoids more invasive procedures such as lung surgical biopsies for these often critically ill patients.