bronchiolitis obliterans Flashcards
def and causes
acute common often severe respiratory illness of children under 2y caused by respiratory syncytial virus and mycoplasma pneumonia
bronchiolitis obliterans: 5 types,
- toxic fume bronchiolitis obliterans
- post infectious bronchiolitis obliterans
- bronchiolitis obliterans associated with connective tissue disease and organ transplantation
- bronchiolitis obliterans associated with localized lung lesions
- Idiopathic bronchiolitis obliterans with organizing pneumonia
bronchiolitis obliterans: in adults?
is adulte is probably under recognized
bronchiolitis obliterans: sx
cough, dyspnea, crackles on chest auscultation and obstructive pulmonary dysfunction are characteristic
bronchiolitis obliterans: toxic flume bronchiolitis obliterans: follows 1-3 weeks after exposure of? on chest Xray?
- > nitrogen, phosphorent and other noxious gases
- > shows diffuse non-specific alveolar or “ground-glass” densities
Postinfectious bronchiolitis obliterans: late response to?
to mycoplasma or viral lung infection in adults and has a highly variable radiographic appearance
bronchiolitis obliterans may occur in association with?
with rheumatoid arthritis, polymyositis and dermatomyositis
what’s the possible cause of bronchiolitis obliterans in pt with rheumatoid arthritis?
Penicillamine therapy
bronchiolitis obliterans is a common complication of?
heart - lung transplantation
how is idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP)? what are the sx? Physical exam?
-> this idiomatic disorder is also called cryptogenic organizing pneumonia (COP), it affect men = women
-> Sx: dry cough, dyspnea, flu like illness raging from a few days to several months
fever and weight loss are common
-> physical exam: crackles, wheezing in about 1/3, clubbing is uncommon.
bronchiolitis obliterans: pulmonary function studies; chest Xray
restrictive dysfunction and hypoxemia
-> chest xray: patchy, bilateral, ground or alveolar infiltrates.
BOOB is a usually difficult diagnosis to make on clinical grounds alone
how can the clinician can distinguish this entity from idiopathic pulmonary fibrosis?
-> the presence of fever and weight loss abrupt onset of sx (often with an upper respiratory tract infection), a relatively short durations of sx; the absence of clubbing and the presence of alveolar infiltrates help the clinician
frequently open lung biopsy may be necessary.
bronchiolitis obliterans: therapy
- > corticosteroid therapy is effective in two/third of cases
- > relapses are common if corticosteroids are stopped prematurely, and most patients require at least 9-12 months threrapy.
- > prednisone is usually given initialy in doses of 1 mg/kg/d for 2-3 months; the dose is then tapered slowly to 20-40 mg/d, depending on the response, and eventually to an alternate day regimen
Respiratory bronchiolitis: def, how does it look clinically and radiographically ?
- > is a disorder of small airways in young cigarette smokers
- > clinically and radiographically is resembles idiopathic pulmonary fibrosis
Respiratory bronchiolitis: Sx, how is the lung biopsy?
- > cough, dyspnea, crackles
- > the condition may be recognized only on open lung biopsy = demonstrates characteristic metaplasia of terminal and respiratory bronchioles and filling of respiratory and terminal bronchioles, alveolar ducts and alveoli by pigment alveolar macrophages.
