Obliterative (Constrictive) Bronchiolitis

Joseph P. Lynch III; S. Samuel Weigt; Ariss DerHovanessian; Michael C. Fishbein; Antonio Gutierrez; John A. Belperio

doi:10.1055/s-0032-1325161

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2012; 33(05): 509-532
DOI: 10.1055/s-0032-1325161

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obliterative (Constrictive) Bronchiolitis

Joseph P. Lynch III

¹Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California

,

S. Samuel Weigt

¹Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California

,

Ariss DerHovanessian

¹Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California

,

Michael C. Fishbein

³Department of Pathology and Laboratory Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California

,

Antonio Gutierrez

²Department of Radiology, The David Geffen School of Medicine at UCLA, Los Angeles, California

,

John A. Belperio

¹Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California

› Author Affiliations

Abstract

Obliterative bronchiolitis (OB) (formerly termed bronchiolitis obliterans), is a rare fibrotic disorder involving terminal and respiratory bronchioles. The term constrictive bronchiolitis is synonymous with OB. Clinically, OB is characterized by progressive (often fatal) airflow obstruction, the absence of parenchymal infiltrates on chest radiographs, a mosaic pattern of perfusion on high-resolution computed tomographic scan, poor responsiveness to therapy, and high mortality rates. Most cases of OB occur in the context of a specific risk factor. Currently, most cases of OB occur in lung transplant recipients with chronic allograft rejection or hematopoietic stem cell transplant (HSCT) recipients with graft versus host disease (GVHD). Other causes of OB include connective tissue disease (CTD) (particularly rheumatoid arthritis); lower respiratory tract infections; inhalation injury; exposure or inhalation of toxic fumes, metals, dusts, particulate matter, or pollutants; occupational exposures; drug reactions; consumption of uncooked leaves of Sauropus androgynus; chronic hypersensitivity pneumonia; diffuse neuroendocrine cell hyperplasia; miscellaneous. When no cause is identified, the term cryptogenic obliterative bronchiolitis is used. This review discusses the salient clinical, radiographic, and histological features of OB and presents a management approach.

Keywords

bronchiolitis obliterans - obliterative bronchiolitis - constrictive bronchiolitis - bronchiolitis obliterans syndrome - chronic lung allograft rejection - hematopoietic stem cell transplant

Full Text

References

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