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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
1   Division 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
1   Division 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
1   Division 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
3   Department of Pathology and Laboratory Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
,
Antonio Gutierrez
2   Department of Radiology, The David Geffen School of Medicine at UCLA, Los Angeles, California
,
John A. Belperio
1   Division 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
Further Information

Publication History

Publication Date:
21 September 2012 (online)

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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
 

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