Obstructive bronchiolar disease identified by CT in the non‐transplant population: Analysis of 29 consecutive cases
Identifieur interne : 001593 ( Istex/Corpus ); précédent : 001592; suivant : 001594Obstructive bronchiolar disease identified by CT in the non‐transplant population: Analysis of 29 consecutive cases
Auteurs : Joseph G. Parambil ; Eunhee S. Yi ; Jay H. RyuSource :
- Respirology [ 1323-7799 ] ; 2009-04.
Abstract
Background and objective: Obstructive bronchiolar disease or constrictive bronchiolitis, particularly in non‐transplant patients, is poorly understood. This study identified the associated diseases, presenting features, and clinical course of obstructive bronchiolar disease identified by CT in the non‐transplant adult population. Methods: Retrospective single‐centre study of 29 consecutive patients clinically diagnosed to have an obstructive bronchiolar disease based on the presence of respiratory symptoms and abnormal CT findings consisting of mosaic perfusion pattern with air trapping. Results: The median age was 54 years (range, 25–80 years); 20 were women (69%) and four patients (14%) had a smoking history. All 29 patients presented with respiratory symptoms, predominantly dyspnoea. The most common cause of obstructive bronchiolar disease was rheumatoid arthritis (34%). Other causes included hypersensitivity pneumonitis, multiple carcinoid tumorlets, Sjögren's syndrome, paraneoplastic pemphigus, inflammatory bowel disease and Swyer–James syndrome. The underlying cause was not identifiable in nine patients (31%), that is, cryptogenic constrictive bronchiolitis. An obstructive pattern was seen on pulmonary function testing in most patients (86%) with the exception of those with hypersensitivity pneumonitis and extreme obesity. Management usually included corticosteroid therapy, inhaled and oral, and bronchodilator therapy. Additional medications included macrolides, cytotoxic agents and other immunomodulator therapy. Pharmacologic therapy did not provide improvement in pulmonary function in the majority of patients but the follow‐up data were limited. Conclusions: Diverse causes and underlying diseases are associated with obstructive bronchiolar disease diagnosed radiologically in the non‐transplant adult population. Rheumatoid arthritis‐associated and cryptogenic constrictive bronchiolitis are found in over one‐half of these patients. Most patients with obstructive bronchiolar disease do not appear to improve with currently available therapy.
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DOI: 10.1111/j.1440-1843.2008.01445.x
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Ryu</name><affiliation><mods:affiliation>Division of Pulmonary and Critical Care Medicine and</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Respirology</title><title level="j" type="alt">RESPIROLOGY</title><idno type="ISSN">1323-7799</idno><idno type="eISSN">1440-1843</idno><imprint><biblScope unit="vol">14</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="443">443</biblScope><biblScope unit="page" to="448">448</biblScope><biblScope unit="page-count">6</biblScope><publisher>Blackwell Publishing Asia</publisher><pubPlace>Melbourne, Australia</pubPlace><date type="published" when="2009-04">2009-04</date></imprint><idno type="ISSN">1323-7799</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1323-7799</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background and objective: Obstructive bronchiolar disease or constrictive bronchiolitis, particularly in non‐transplant patients, is poorly understood. This study identified the associated diseases, presenting features, and clinical course of obstructive bronchiolar disease identified by CT in the non‐transplant adult population. Methods: Retrospective single‐centre study of 29 consecutive patients clinically diagnosed to have an obstructive bronchiolar disease based on the presence of respiratory symptoms and abnormal CT findings consisting of mosaic perfusion pattern with air trapping. Results: The median age was 54 years (range, 25–80 years); 20 were women (69%) and four patients (14%) had a smoking history. All 29 patients presented with respiratory symptoms, predominantly dyspnoea. The most common cause of obstructive bronchiolar disease was rheumatoid arthritis (34%). Other causes included hypersensitivity pneumonitis, multiple carcinoid tumorlets, Sjögren's syndrome, paraneoplastic pemphigus, inflammatory bowel disease and Swyer–James syndrome. The underlying cause was not identifiable in nine patients (31%), that is, cryptogenic constrictive bronchiolitis. An obstructive pattern was seen on pulmonary function testing in most patients (86%) with the exception of those with hypersensitivity pneumonitis and extreme obesity. Management usually included corticosteroid therapy, inhaled and oral, and bronchodilator therapy. Additional medications included macrolides, cytotoxic agents and other immunomodulator therapy. Pharmacologic therapy did not provide improvement in pulmonary function in the majority of patients but the follow‐up data were limited. Conclusions: Diverse causes and underlying diseases are associated with obstructive bronchiolar disease diagnosed radiologically in the non‐transplant adult population. Rheumatoid arthritis‐associated and cryptogenic constrictive bronchiolitis are found in over one‐half of these patients. 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RYU</name><affiliations><json:string>Division of Pulmonary and Critical Care Medicine and</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>bronchiolitis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>bronchiolitis obliterans</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>computed tomography</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>obstructive lung disease</value></json:item></subject><articleId><json:string>RESP1445</json:string></articleId><arkIstex>ark:/67375/WNG-L632J73B-V</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>reviewArticle</json:string></originalGenre><abstract>Background and objective: Obstructive bronchiolar disease or constrictive bronchiolitis, particularly in non‐transplant patients, is poorly understood. This study identified the associated diseases, presenting features, and clinical course of obstructive bronchiolar disease identified by CT in the non‐transplant adult population. Methods: Retrospective single‐centre study of 29 consecutive patients clinically diagnosed to have an obstructive bronchiolar disease based on the presence of respiratory symptoms and abnormal CT findings consisting of mosaic perfusion pattern with air trapping. Results: The median age was 54 years (range, 25–80 years); 20 were women (69%) and four patients (14%) had a smoking history. All 29 patients presented with respiratory symptoms, predominantly dyspnoea. The most common cause of obstructive bronchiolar disease was rheumatoid arthritis (34%). Other causes included hypersensitivity pneumonitis, multiple carcinoid tumorlets, Sjögren's syndrome, paraneoplastic pemphigus, inflammatory bowel disease and Swyer–James syndrome. The underlying cause was not identifiable in nine patients (31%), that is, cryptogenic constrictive bronchiolitis. An obstructive pattern was seen on pulmonary function testing in most patients (86%) with the exception of those with hypersensitivity pneumonitis and extreme obesity. Management usually included corticosteroid therapy, inhaled and oral, and bronchodilator therapy. Additional medications included macrolides, cytotoxic agents and other immunomodulator therapy. Pharmacologic therapy did not provide improvement in pulmonary function in the majority of patients but the follow‐up data were limited. Conclusions: Diverse causes and underlying diseases are associated with obstructive bronchiolar disease diagnosed radiologically in the non‐transplant adult population. Rheumatoid arthritis‐associated and cryptogenic constrictive bronchiolitis are found in over one‐half of these patients. 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<ref target="http://www.tei-c.org/">We use TEI</ref></desc></application></appInfo></encodingDesc><profileDesc><abstract xml:lang="en" style="main"><head>ABSTRACT</head><p><hi rend="bold">Background and objective: </hi> Obstructive bronchiolar disease or constrictive bronchiolitis, particularly in non‐transplant patients, is poorly understood. This study identified the associated diseases, presenting features, and clinical course of obstructive bronchiolar disease identified by CT in the non‐transplant adult population.</p><p><hi rend="bold">Methods: </hi> Retrospective single‐centre study of 29 consecutive patients clinically diagnosed to have an obstructive bronchiolar disease based on the presence of respiratory symptoms and abnormal CT findings consisting of mosaic perfusion pattern with air trapping.</p><p><hi rend="bold">Results: </hi> The median age was 54 years (range, 25–80 years); 20 were women (69%) and four patients (14%) had a smoking history. All 29 patients presented with respiratory symptoms, predominantly dyspnoea. The most common cause of obstructive bronchiolar disease was rheumatoid arthritis (34%). Other causes included hypersensitivity pneumonitis, multiple carcinoid tumorlets, Sjögren's syndrome, paraneoplastic pemphigus, inflammatory bowel disease and Swyer–James syndrome. The underlying cause was not identifiable in nine patients (31%), that is, cryptogenic constrictive bronchiolitis. An obstructive pattern was seen on pulmonary function testing in most patients (86%) with the exception of those with hypersensitivity pneumonitis and extreme obesity. Management usually included corticosteroid therapy, inhaled and oral, and bronchodilator therapy. Additional medications included macrolides, cytotoxic agents and other immunomodulator therapy. Pharmacologic therapy did not provide improvement in pulmonary function in the majority of patients but the follow‐up data were limited.</p><p><hi rend="bold">Conclusions: </hi> Diverse causes and underlying diseases are associated with obstructive bronchiolar disease diagnosed radiologically in the non‐transplant adult population. Rheumatoid arthritis‐associated and cryptogenic constrictive bronchiolitis are found in over one‐half of these patients. Most patients with obstructive bronchiolar disease do not appear to improve with currently available therapy.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">bronchiolitis</term><term xml:id="k2">bronchiolitis obliterans</term><term xml:id="k3">computed tomography</term><term xml:id="k4">obstructive lung disease</term></keywords><keywords rend="tocHeading1"><term>CASE REVIEW</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc><revisionDesc><change when="2019-12-20" who="#istex" xml:id="pub2tei">formatting</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-L632J73B-V/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Asia</publisherName><publisherLoc>Melbourne, Australia</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1440-1843</doi><issn type="print">1323-7799</issn><issn type="electronic">1440-1843</issn><idGroup><id type="product" value="RESP"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="RESPIROLOGY">Respirology</title></titleGroup></publicationMeta><publicationMeta level="part" position="04003"><doi origin="wiley">10.1111/res.2009.14.issue-3</doi><numberingGroup><numbering type="journalVolume" number="14">14</numbering><numbering type="journalIssue" number="3">3</numbering></numberingGroup><coverDate startDate="2009-04">April 2009</coverDate></publicationMeta><publicationMeta level="unit" type="reviewArticle" position="23" status="forIssue"><doi origin="wiley">10.1111/j.1440-1843.2008.01445.x</doi><idGroup><id type="unit" value="RESP1445"></id></idGroup><countGroup><count type="pageTotal" number="6"></count></countGroup><titleGroup><title type="tocHeading1">CASE REVIEW</title></titleGroup><copyright>© 2008 The Authors. Journal compilation © 2008 Asian Pacific Society of Respirology</copyright><eventGroup><event type="firstOnline" date="2008-12-16"></event><event type="publishedOnlineFinalForm" date="2009-03-29"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-02-28"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-08"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-03"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="443">443</numbering><numbering type="pageLast" number="448">448</numbering></numberingGroup><correspondenceTo>Jay H. Ryu, Division of Pulmonary and Critical Care Medicine, Desk East 18, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Email: <email>ryu.jay@mayo.edu</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:RESP.RESP1445.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received 2 May 2008; invited to revise 9 July 2008; revised 11 July 2008; accepted 12 August 2008 (Associate Editor: Jeffrey Swigris).</unparsedEditorialHistory><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="4"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="35"></count><count type="wordTotal" number="4260"></count><count type="linksPubMed" number="0"></count><count type="linksCrossRef" number="0"></count></countGroup><titleGroup><title type="main">Obstructive bronchiolar disease identified by CT in the non‐transplant population: Analysis of 29 consecutive cases</title><title type="shortAuthors">JG Parambil <i>et al.</i></title><title type="short">Obstructive bronchiolar disease</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Joseph G.</givenNames><familyName>PARAMBIL</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a2"><personName><givenNames>Eunhee S.</givenNames><familyName>YI</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>Jay H.</givenNames><familyName>RYU</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Division of Pulmonary and Critical Care Medicine and</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="US"><unparsedAffiliation>Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">bronchiolitis</keyword><keyword xml:id="k2">bronchiolitis obliterans</keyword><keyword xml:id="k3">computed tomography</keyword><keyword xml:id="k4">obstructive lung disease</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">ABSTRACT</title><p><b>Background and objective: </b> Obstructive bronchiolar disease or constrictive bronchiolitis, particularly in non‐transplant patients, is poorly understood. This study identified the associated diseases, presenting features, and clinical course of obstructive bronchiolar disease identified by CT in the non‐transplant adult population.</p><p><b>Methods: </b> Retrospective single‐centre study of 29 consecutive patients clinically diagnosed to have an obstructive bronchiolar disease based on the presence of respiratory symptoms and abnormal CT findings consisting of mosaic perfusion pattern with air trapping.</p><p><b>Results: </b> The median age was 54 years (range, 25–80 years); 20 were women (69%) and four patients (14%) had a smoking history. All 29 patients presented with respiratory symptoms, predominantly dyspnoea. The most common cause of obstructive bronchiolar disease was rheumatoid arthritis (34%). Other causes included hypersensitivity pneumonitis, multiple carcinoid tumorlets, Sjögren's syndrome, paraneoplastic pemphigus, inflammatory bowel disease and Swyer–James syndrome. The underlying cause was not identifiable in nine patients (31%), that is, cryptogenic constrictive bronchiolitis. An obstructive pattern was seen on pulmonary function testing in most patients (86%) with the exception of those with hypersensitivity pneumonitis and extreme obesity. Management usually included corticosteroid therapy, inhaled and oral, and bronchodilator therapy. Additional medications included macrolides, cytotoxic agents and other immunomodulator therapy. Pharmacologic therapy did not provide improvement in pulmonary function in the majority of patients but the follow‐up data were limited.</p><p><b>Conclusions: </b> Diverse causes and underlying diseases are associated with obstructive bronchiolar disease diagnosed radiologically in the non‐transplant adult population. Rheumatoid arthritis‐associated and cryptogenic constrictive bronchiolitis are found in over one‐half of these patients. Most patients with obstructive bronchiolar disease do not appear to improve with currently available therapy.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Obstructive bronchiolar disease identified by CT in the non‐transplant population: Analysis of 29 consecutive cases</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Obstructive bronchiolar disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Obstructive bronchiolar disease identified by CT in the non‐transplant population: Analysis of 29 consecutive cases</title></titleInfo><name type="personal"><namePart type="given">Joseph G.</namePart><namePart type="family">PARAMBIL</namePart><affiliation>Division of Pulmonary and Critical Care Medicine and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Eunhee S.</namePart><namePart type="family">YI</namePart><affiliation>Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jay H.</namePart><namePart type="family">RYU</namePart><affiliation>Division of Pulmonary and Critical Care Medicine and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="review-article" displayLabel="reviewArticle" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-L5L7X3NF-P">review-article</genre><originInfo><publisher>Blackwell Publishing Asia</publisher><place><placeTerm type="text">Melbourne, Australia</placeTerm></place><dateIssued encoding="w3cdtf">2009-04</dateIssued><edition>Received 2 May 2008; invited to revise 9 July 2008; revised 11 July 2008; accepted 12 August 2008 (Associate Editor: Jeffrey Swigris).</edition><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">1</extent><extent unit="tables">4</extent><extent unit="formulas">0</extent><extent unit="references">35</extent><extent unit="linksCrossRef">0</extent><extent unit="words">4260</extent></physicalDescription><abstract lang="en">Background and objective: Obstructive bronchiolar disease or constrictive bronchiolitis, particularly in non‐transplant patients, is poorly understood. This study identified the associated diseases, presenting features, and clinical course of obstructive bronchiolar disease identified by CT in the non‐transplant adult population. Methods: Retrospective single‐centre study of 29 consecutive patients clinically diagnosed to have an obstructive bronchiolar disease based on the presence of respiratory symptoms and abnormal CT findings consisting of mosaic perfusion pattern with air trapping. Results: The median age was 54 years (range, 25–80 years); 20 were women (69%) and four patients (14%) had a smoking history. All 29 patients presented with respiratory symptoms, predominantly dyspnoea. The most common cause of obstructive bronchiolar disease was rheumatoid arthritis (34%). Other causes included hypersensitivity pneumonitis, multiple carcinoid tumorlets, Sjögren's syndrome, paraneoplastic pemphigus, inflammatory bowel disease and Swyer–James syndrome. The underlying cause was not identifiable in nine patients (31%), that is, cryptogenic constrictive bronchiolitis. An obstructive pattern was seen on pulmonary function testing in most patients (86%) with the exception of those with hypersensitivity pneumonitis and extreme obesity. Management usually included corticosteroid therapy, inhaled and oral, and bronchodilator therapy. Additional medications included macrolides, cytotoxic agents and other immunomodulator therapy. Pharmacologic therapy did not provide improvement in pulmonary function in the majority of patients but the follow‐up data were limited. Conclusions: Diverse causes and underlying diseases are associated with obstructive bronchiolar disease diagnosed radiologically in the non‐transplant adult population. Rheumatoid arthritis‐associated and cryptogenic constrictive bronchiolitis are found in over one‐half of these patients. 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