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Bronchiolitis in adults

INTRODUCTION

Bronchiolitis and bronchiolitis obliterans are general terms used to describe a nonspecific inflammatory injury that primarily affects the small airways (eg, less than 2 mm in diameter), often sparing a considerable portion of the interstitium [1-3]. The terms are often confusing because they describe both a clinical syndrome and a constellation of histopathologic abnormalities that may occur in a variety of disorders [4]. Unfortunately, much of the literature about bronchiolitis consists of isolated case reports or small case series. In addition, tissue confirmation of the diagnosis has not been described in many of these reports [5]. As a result, many uncertainties remain regarding the epidemiology, pathophysiology, long-term sequelae, and therapy of bronchiolitis. The most important clinical syndromes associated with bronchiolitis are listed in the table (table 1) [3,6].

An overview of bronchiolitis in adults is provided here. The acute infectious bronchiolitis that occurs predominantly in young children is described separately. (See "Bronchiolitis in infants and children: Clinical features and diagnosis" and "Bronchiolitis in infants and children: Treatment; outcome; and prevention".)

A discussion of the idiopathic form of organizing pneumonia also known as bronchiolitis obliterans organizing pneumonia (BOOP) is provided separately. (See "Cryptogenic organizing pneumonia".) "BOOP" refers to disorders characterized histologically by intraluminal polyps in the respiratory bronchioles, alveolar ducts, and alveolar spaces, accompanied by organizing pneumonia in the more distal parenchyma.

Another potentially confusing entity is bronchiolitis obliterans syndrome (BOS). BOS is a clinical term that refers to the progressive airflow limitation caused by small airway obstruction that may occur following lung transplantation. BOS is defined by lung function changes, not by histology. (See "Chronic lung transplant rejection: Bronchiolitis obliterans".)

PATHOGENESIS

In most instances, the pathogenesis of bronchiolitis remains poorly defined. Injury to the bronchiolar epithelium appears to initiate the process (figure 1). The alveoli immediately adjacent to the small airways are also frequently involved. The repair process may result in complete recovery or may be characterized by excessive proliferation of granulation tissue that causes narrowing or obliteration of the airway lumen. In some cases, fibrosis is primarily submucosal and peribronchiolar in distribution, resulting in extrinsic narrowing or obliteration of the bronchiolar lumen.

                  

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Literature review current through: Mar 2014. | This topic last updated: May 2, 2013.
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References
Top
  1. Ryu JH, Myers JL, Swensen SJ. Bronchiolar disorders. Am J Respir Crit Care Med 2003; 168:1277.
  2. King TE Jr. Overview of bronchiolitis. Clin Chest Med 1993; 14:607.
  3. King TE Jr. Bronchiolitis. In: Interstitial Lung Disease, 4th ed, King TE Jr, Schwarz MI (Eds), B.C. Decker, Hamilton, ON, Canada 2003. p.787.
  4. Colby, TV, Myers, JL. The clinical and histologic spectrum of bronchiolitis obliterans including bronchiolitis obliterans organizing pneumonia (BOOP). Semin Respir Med 1992; 13:119.
  5. Green M, Turton CW. Bronchiolitis and its manifestations. Eur J Respir Dis Suppl 1982; 121:36.
  6. Cordier JF. Challenges in pulmonary fibrosis. 2: Bronchiolocentric fibrosis. Thorax 2007; 62:638.
  7. Epler GR, Colby TV. The spectrum of bronchiolitis obliterans. Chest 1983; 83:161.
  8. Myers JL, Colby TV. Pathologic manifestations of bronchiolitis, constrictive bronchiolitis, cryptogenic organizing pneumonia, and diffuse panbronchiolitis. Clin Chest Med 1993; 14:611.
  9. Hendrick DJ. "Popcorn worker's lung" in Britain in a man making potato crisp flavouring. Thorax 2008; 63:267.
  10. van Rooy FG, Rooyackers JM, Prokop M, et al. Bronchiolitis obliterans syndrome in chemical workers producing diacetyl for food flavorings. Am J Respir Crit Care Med 2007; 176:498.
  11. Hsiue TR, Guo YL, Chen KW, et al. Dose-response relationship and irreversible obstructive ventilatory defect in patients with consumption of Sauropus androgynus. Chest 1998; 113:71.
  12. Lockey JE, Hilbert TJ, Levin LP, et al. Airway obstruction related to diacetyl exposure at microwave popcorn production facilities. Eur Respir J 2009; 34:63.
  13. Harber P, Levine J, Bansal S. How frequently should workplace spirometry screening be performed?: optimization via analytic models. Chest 2009; 136:1086.
  14. Centers for Disease Control and Prevention (CDC). Obliterative bronchiolitis in workers in a coffee-processing facility - Texas, 2008-2012. MMWR Morb Mortal Wkly Rep 2013; 62:305.
  15. Garg K, Lynch DA, Newell JD, King TE Jr. Proliferative and constrictive bronchiolitis: classification and radiologic features. AJR Am J Roentgenol 1994; 162:803.
  16. Visscher DW, Myers JL. Bronchiolitis: the pathologist's perspective. Proc Am Thorac Soc 2006; 3:41.
  17. Ghanei M, Tazelaar HD, Chilosi M, et al. An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. Respir Med 2008; 102:825.
  18. King MS, Eisenberg R, Newman JH, et al. Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med 2011; 365:222.
  19. Pipavath SJ, Lynch DA, Cool C, et al. Radiologic and pathologic features of bronchiolitis. AJR Am J Roentgenol 2005; 185:354.
  20. Romero S, Barroso E, Gil J, et al. Follicular bronchiolitis: clinical and pathologic findings in six patients. Lung 2003; 181:309.
  21. Yousem SA, Dacic S. Idiopathic bronchiolocentric interstitial pneumonia. Mod Pathol 2002; 15:1148.
  22. Yi XH, Chu HQ, Cheng XM, et al. Idiopathic airway-centered interstitial fibrosis: report of two cases. Chin Med J (Engl) 2007; 120:847.
  23. Churg A, Myers J, Suarez T, et al. Airway-centered interstitial fibrosis: a distinct form of aggressive diffuse lung disease. Am J Surg Pathol 2004; 28:62.
  24. de Carvalho ME, Kairalla RA, Capelozzi VL, et al. Centrilobular fibrosis: a novel histological pattern of idiopathic interstitial pneumonia. Pathol Res Pract 2002; 198:577.
  25. Fukuoka J, Franks TJ, Colby TV, et al. Peribronchiolar metaplasia: a common histologic lesion in diffuse lung disease and a rare cause of interstitial lung disease: clinicopathologic features of 15 cases. Am J Surg Pathol 2005; 29:948.
  26. Hwang JH, Kim TS, Lee KS, et al. Bronchiolitis in adults: pathology and imaging. J Comput Assist Tomogr 1997; 21:913.
  27. Lynch DA. Imaging of small airways disease and chronic obstructive pulmonary disease. Clin Chest Med 2008; 29:165.
  28. Devakonda A, Raoof S, Sung A, et al. Bronchiolar disorders: a clinical-radiological diagnostic algorithm. Chest 2010; 137:938.
  29. Jensen SP, Lynch DA, Brown KK, et al. High-resolution CT features of severe asthma and bronchiolitis obliterans. Clin Radiol 2002; 57:1078.
  30. Howling SJ, Hansell DM, Wells AU, et al. Follicular bronchiolitis: thin-section CT and histologic findings. Radiology 1999; 212:637.
  31. Nagai H, Shishido H, Yoneda R, et al. Long-term low-dose administration of erythromycin to patients with diffuse panbronchiolitis. Respiration 1991; 58:145.
  32. Azuma A, Kudoh S. Securing the safety and efficacy of macrolide therapy for chronic small airway diseases. Intern Med 2005; 44:167.
  33. Khalid M, Al Saghir A, Saleemi S, et al. Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study. Eur Respir J 2005; 25:490.
  34. Yang M, Dong BR, Lu J, et al. Macrolides for diffuse panbronchiolitis. Cochrane Database Syst Rev 2010; :CD007716.
  35. King TE Jr, Mortenson RL. Cryptogenic organizing pneumonitis. The North American experience. Chest 1992; 102:8S.
  36. Cortot AB, Cottin V, Miossec P, et al. Improvement of refractory rheumatoid arthritis-associated constrictive bronchiolitis with etanercept. Respir Med 2005; 99:511.