Clinical analysis of obliterative bronchiolitis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Hong , Nadila·Abulizi ,  PENG Min , CAI Baiqiang

Department of Respiratory Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, P. R. China;

Corresponding author：

PENG Min, Email: pengmin@pumch.cn

Keywords：

Bronchiolitis; Obliterative bronchiolitis

DOI：

10.7507/1671-6205.201808049

Video：

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Objective To investigate the etiology and the clinical features of obliterative bronchiolitis (OB). Methods Sixteen admitted patients were diagnosed as OB in Peking Union Medical College Hospital from Jan 1990 to May 2018. The case records were reviewed retrospectively. Results Twelve patients were female and 4 patients were male. The median age was 33.5 years (ranged from 17 to 55). The common symptoms included: exertional dyspnea in 15 patients (94%), cough in 10 patients (63%), phlegm production in 8 patients (50%). All of the 16 patients had associated conditions: paraneoplastic pemphigus in 6 patients (Castleman’s disease, lymphoproliferative disorder, inflammatory myofibroblastic tumor and follicular dendritic cell tumor respectively), chronic graft-versus-host disease after hematopoietic stem-cell transplantation in 3 patients, thymoma in 2 patients, Behcet’s disease, Sjögren syndrome, multiple myeloma, myasthenia gravis, and oral lichen planus in 1 patient respectively. The pulmonary function tests revealed severe or very severe obstructive ventilatory defect in all 16 patients. The CT scans showed slight ground-glass opacities in 10 patients, decreased attenuation of lung in 9 patients, mosaic attenuation in 8 patients, bronchiectasis in 7 patients, and air trapping in 3 patients. Conclusions OB is a clinical syndrome characterized by progressive airway obstruction, resulting from a variety of exposures or diseases. In most cases, diagnosis can be obtained on the basis of typical clinical, physiological, and radiological features, combined with OB-related diseases or exposures. Surgical lung biopsy can help diagnosis but risk-benefit should be taken into consideration seriously.

Citation： ZHANG Hong, Nadila·Abulizi, PENG Min, CAI Baiqiang. Clinical analysis of obliterative bronchiolitis. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(3): 241-246. doi: 10.7507/1671-6205.201808049 Copy

1.	Barker AF, Bergeron A, Rom WN, et al. Obliterative bronchiolitis. N Engl J Med, 2014, 370(19): 1820-1828.
2.	Chien JW, Duncan S, Williams KM, et al. Bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation-an increasingly recognized manifestation of chronic graft-versus-host disease. Biol Blood Marrow Transplant, 2010, 16(1 Suppl): S106-S114.
3.	Khateri S, Ghanei M, Keshavarz S, et al. Incidence of lung, eye, and skin lesions as late complications in 34, 000 Iranians with wartime exposure to mustard agent. J Occup Environ Med, 2003, 45(11): 1136-1143.
4.	Ghanei M, Mokhtari M, Mohammad MM, et al. Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography. Eur J Radiol, 2004, 52(2): 164-169.
5.	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(6): 825-830.
6.	Parmet AJ. Bronchiolitis in popcorn-factory workers. N Engl J Med, 2002, 347(24): 1980-1982.
7.	Parmet AJ, Von Essen S. Rapidly progressive, fixed airway obstructive disease in popcorn workers: a new occupational pulmonary illness?. J Occup Environ Med, 2002, 44(3): 216-218.
8.	Kreiss K, Gomaa A, Kullman G, et al. Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. N Engl J Med, 2002, 347(5): 330-338.
9.	Chang AB, Masel JP, Masters B. Post-infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae. Pediatr Radiol, 1998, 28(1): 23-29.
10.	Kim CK, Kim SW, Kim JS, et al. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest, 2001, 120(4): 1101-1106.
11.	Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings. Am J Respir Crit Care Med, 1998, 157(5 Pt 1): 1658-1665.
12.	甄俊锋, 张路, 曹欣欣, 等. 合并副肿瘤天疱疮及闭塞性细支气管炎的单中心型 Castleman 病临床分析. 中国医学科学院学报, 2017, 39(4): 492-498.
13.	Jindal T, Meena M, Kumar A, et al. Paraneoplastic pemphigus with Castleman's disease and bronchiolitis obliterans. Pediatr Int, 2011, 53(6): 1108-1109.
14.	Morikawa K, Tsuji T, Yamasaki H, et al. Paraneoplastic pemphigus occurs most commonly in indolent B cell lymphoma. Acta Haematol, 2014, 132(1): 73-74.
15.	Lee J, Bloom R, Amber KT. A systematic review of patients with mucocutaneous and respiratory complications in paraneoplastic autoimmune multiorgan syndrome: Castleman's disease is the predominant malignancy. Lung, 2015, 193(4): 593-596.
16.	Aguilar PR, Michelson AP, Isakow W. Obliterative bronchiolitis. Transplantation, 2016, 100(2): 272-283.
17.	Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant, 2012, 31(10): 1073-1086.
18.	Au BK, Au MA, Chien JW. Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant, 2011, 17(7): 1072-1078.
19.	Yen KT, Lee AS, Krowka MJ, et al. Pulmonary complications in bone marrow transplantation: a practical approach to diagnosis and treatment. Clin Chest Med, 2004, 25(1): 189-201.
20.	Shi JH, Liu HR, Xu WB, et al. Pulmonary manifestations of Sjogren's syndrome. Respiration, 2009, 78(4): 377-386.
21.	Reynaers A, Degreef H. Severe erosive stomatitis: association with immunological diseases?. Dermatology (Basel, Switzerland), 1997, 194(4): 411-415.
22.	Zhu X, Zhang B. Paraneoplastic pemphigus. J Dermatol, 2007, 34(8): 503-511.
23.	Devakonda A, Raoof S, Sung A, et al. Bronchiolar disorders: a clinical-radiological diagnostic algorithm. Chest, 2010, 137(4): 938-951.
24.	Hansell DM, Lynch DA, McAdams HP, et al. Imaging of Diseases of the Chest. 5th edition. Mosby, 2009: 189-191.
25.	Lynch JP 3rd, Weigt SS, DerHovanessian A, et al. Obliterative (constrictive) bronchiolitis. Semin Respir Crit Care Med, 2012, 33(5): 509-532.
26.	Estenne M, Maurer JR, Boehler A, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant, 2002, 21(3): 297-310.
27.	Flowers ME, Martin PJ. How we treat chronic graft-versus-host disease. 2015, 125(4): 606-615.
28.	Bergeron A, Belle A, Chevret S, et al. Combined inhaled steroids and bronchodilatators in obstructive airway disease after allogeneic stem cell transplantation. Bone Marrow Transplant, 2007, 39(9): 547-553.
29.	Bergeron A, Chevret S, Chagnon K, et al. Budesonide/Formoterol for bronchiolitis obliterans after hematopoietic stem cell transplantation. Am J Respir Crit Care Med, 2015, 191(11): 1242-1249.
30.	Williams KM, Cheng GS, Pusic I, et al. Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Biol Blood Marrow Transplant, 2016, 22(4): 710-716.
31.	Williams KM. How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Blood, 2017, 129(4): 448-455.
32.	Norman BC, Jacobsohn DA, Williams KM, et al. Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients. Bone Marrow Transplant, 2011, 46(10): 1369-1373.

1. Barker AF, Bergeron A, Rom WN, et al. Obliterative bronchiolitis. N Engl J Med, 2014, 370(19): 1820-1828.
2. Chien JW, Duncan S, Williams KM, et al. Bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation-an increasingly recognized manifestation of chronic graft-versus-host disease. Biol Blood Marrow Transplant, 2010, 16(1 Suppl): S106-S114.
3. Khateri S, Ghanei M, Keshavarz S, et al. Incidence of lung, eye, and skin lesions as late complications in 34, 000 Iranians with wartime exposure to mustard agent. J Occup Environ Med, 2003, 45(11): 1136-1143.
4. Ghanei M, Mokhtari M, Mohammad MM, et al. Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography. Eur J Radiol, 2004, 52(2): 164-169.
5. 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(6): 825-830.
6. Parmet AJ. Bronchiolitis in popcorn-factory workers. N Engl J Med, 2002, 347(24): 1980-1982.
7. Parmet AJ, Von Essen S. Rapidly progressive, fixed airway obstructive disease in popcorn workers: a new occupational pulmonary illness?. J Occup Environ Med, 2002, 44(3): 216-218.
8. Kreiss K, Gomaa A, Kullman G, et al. Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. N Engl J Med, 2002, 347(5): 330-338.
9. Chang AB, Masel JP, Masters B. Post-infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae. Pediatr Radiol, 1998, 28(1): 23-29.
10. Kim CK, Kim SW, Kim JS, et al. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest, 2001, 120(4): 1101-1106.
11. Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings. Am J Respir Crit Care Med, 1998, 157(5 Pt 1): 1658-1665.
12. 甄俊锋, 张路, 曹欣欣, 等. 合并副肿瘤天疱疮及闭塞性细支气管炎的单中心型 Castleman 病临床分析. 中国医学科学院学报, 2017, 39(4): 492-498.
13. Jindal T, Meena M, Kumar A, et al. Paraneoplastic pemphigus with Castleman's disease and bronchiolitis obliterans. Pediatr Int, 2011, 53(6): 1108-1109.
14. Morikawa K, Tsuji T, Yamasaki H, et al. Paraneoplastic pemphigus occurs most commonly in indolent B cell lymphoma. Acta Haematol, 2014, 132(1): 73-74.
15. Lee J, Bloom R, Amber KT. A systematic review of patients with mucocutaneous and respiratory complications in paraneoplastic autoimmune multiorgan syndrome: Castleman's disease is the predominant malignancy. Lung, 2015, 193(4): 593-596.
16. Aguilar PR, Michelson AP, Isakow W. Obliterative bronchiolitis. Transplantation, 2016, 100(2): 272-283.
17. Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant, 2012, 31(10): 1073-1086.
18. Au BK, Au MA, Chien JW. Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant, 2011, 17(7): 1072-1078.
19. Yen KT, Lee AS, Krowka MJ, et al. Pulmonary complications in bone marrow transplantation: a practical approach to diagnosis and treatment. Clin Chest Med, 2004, 25(1): 189-201.
20. Shi JH, Liu HR, Xu WB, et al. Pulmonary manifestations of Sjogren's syndrome. Respiration, 2009, 78(4): 377-386.
21. Reynaers A, Degreef H. Severe erosive stomatitis: association with immunological diseases?. Dermatology (Basel, Switzerland), 1997, 194(4): 411-415.
22. Zhu X, Zhang B. Paraneoplastic pemphigus. J Dermatol, 2007, 34(8): 503-511.
23. Devakonda A, Raoof S, Sung A, et al. Bronchiolar disorders: a clinical-radiological diagnostic algorithm. Chest, 2010, 137(4): 938-951.
24. Hansell DM, Lynch DA, McAdams HP, et al. Imaging of Diseases of the Chest. 5th edition. Mosby, 2009: 189-191.
25. Lynch JP 3rd, Weigt SS, DerHovanessian A, et al. Obliterative (constrictive) bronchiolitis. Semin Respir Crit Care Med, 2012, 33(5): 509-532.
26. Estenne M, Maurer JR, Boehler A, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant, 2002, 21(3): 297-310.
27. Flowers ME, Martin PJ. How we treat chronic graft-versus-host disease. 2015, 125(4): 606-615.
28. Bergeron A, Belle A, Chevret S, et al. Combined inhaled steroids and bronchodilatators in obstructive airway disease after allogeneic stem cell transplantation. Bone Marrow Transplant, 2007, 39(9): 547-553.
29. Bergeron A, Chevret S, Chagnon K, et al. Budesonide/Formoterol for bronchiolitis obliterans after hematopoietic stem cell transplantation. Am J Respir Crit Care Med, 2015, 191(11): 1242-1249.
30. Williams KM, Cheng GS, Pusic I, et al. Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Biol Blood Marrow Transplant, 2016, 22(4): 710-716.
31. Williams KM. How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Blood, 2017, 129(4): 448-455.
32. Norman BC, Jacobsohn DA, Williams KM, et al. Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients. Bone Marrow Transplant, 2011, 46(10): 1369-1373.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical analysis of obliterative bronchiolitis

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