Summary
Introduction:
This article, titled "Bronchiolitis Obliterans" by Talmadge E. King Jr., is a comprehensive review of the clinical entity of bronchiolitis obliterans in adults, which was previously considered rare. The review discusses the diverse clinical settings in which bronchiolitis obliterans occurs, including its association with connective tissue diseases, toxic fume exposure, chronic graft versus host reactions, and idiopathic forms of the disease. The article also focuses on the pathophysiology, long-term sequelae, and therapy of bronchiolitis obliterans, highlighting the uncertainties that exist due to the limited number of case reports in the literature.
Key Points:
* Bronchiolitis obliterans is a fibrotic lung disease that primarily affects the small conducting airways, sparing a considerable portion of the interstitium.
* The lesion results from damage to the bronchiolar epithelium and the repair process leads to excessive proliferation of granulation tissue.
* Toxic fume exposure, especially to nitrous fumes, can cause acute respiratory failure and bronchiolitis obliterans.
* Bronchiolitis obliterans may also occur as a result of infectious causes, such as respiratory syncytial virus, adenovirus, and Mycoplasma pneumoniae.
* In some cases, bronchiolitis obliterans may be associated with connective tissue diseases such as rheumatoid arthritis.
* Penicillamine therapy has been implicated in the pathogenesis of bronchiolitis obliterans in patients with rheumatoid arthritis.
* The prognosis for survivors of toxic fume inhalation is good, but those who develop bronchiolitis obliterans may be permanently disabled and experience progressive disease and death over several months.
* The pathogenesis of bronchiolitis obliterans is unclear, and there is no proven role for antibiotics, bronchodilators, or corticosteroids in its management.
Main Message:
The article emphasizes the need for early recognition and treatment of bronchiolitis obliterans to improve outcomes for patients. The review highlights the diverse clinical settings in which bronchiolitis obliterans occurs, which can lead to delays in diagnosis and treatment. The article also underscores the uncertainties that exist regarding the pathophysiology, long-term sequelae, and therapy of bronchiolitis obliterans, highlighting the need for further research to better understand and manage this condition. Overall, the article emphasizes the importance of considering bronchiolitis obliterans as a potential diagnosis in patients with respiratory symptoms, particularly in those with known risk factors.
Citation
King, Talmadge E. “Bronchiolitis Obliterans.” Lung, no. 167 (1989): 69–93.
