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PubMed2005

Impact of palivizumab on admission to the ICU for respiratory syncytial virus bronchiolitis: a national survey.

STUDY OBJECTIVES: To assess the effect of palivizumab licensing for respiratory syncytial virus (RSV) prophylaxis on national pediatric ICU (PICU) admissions and on the need for mechanical ventilation due to RSV bronchiolitis in Israel. DESIGN: Prospective national surveillance survey. SETTING: All PICUs in Israel. PATIENTS OR PARTICIPANTS: All patients admitted to a PICU because of acute bronchiolitis in two consecutive RSV seasons (November 2000 to April 2001 and November 2001 to April 2002). METHODS: Data on demographic and epidemiologic factors and RSV prophylaxis status were collected for every infant with bronchiolitis who was admitted to a PICU in Israel in the year before and after issuance of the Israel Ministry of Health recommendation for palivizumab prophylaxis (January 2001). RESULTS: One hundred five patients were admitted to a PICU because of RSV bronchiolitis in the year before the recommendations were issued, and 123 patients were admitted in the year after they were issued. Mechanical ventilation was required by 33 and 42 children, respectively. Gestational age was > 32 weeks in 92.9% and 83.9% of the admitted patients, respectively, and 89% and 91% of the patients, respectively, were free of chronic lung disease (CLD). In both periods, 83% of the children who were admitted to a PICU did not meet the American Academy of Pediatrics criteria for RSV prophylaxis. CONCLUSIONS: Most of the children with severe RSV bronchiolitis needing PICU admission from 2000 to 2002 born at term did not have CLD and were not candidates for RSV prophylaxis according to the current recommendations.

Antibodies, Monoclonal↗
PubMed2007

Human and murine obliterative bronchiolitis in transplant.

Obliterative bronchiolitis is a devastating illness that limits the long-term success of lung transplantation. Its high prevalence and overall poor response to current therapeutic measures demands further research to elucidate pathogenic mechanisms. Toward this goal, there is a role for animal models to study the mechanisms of obliterative bronchiolitis, such as the murine heterotopic tracheal allograft model. This review compares the tracheal allograft model to human obliterative bronchiolitis pathology and highlights the important mechanisms of airway rejection described using this model. Although certain limitations exist, the pursuit of proof-of-concept studies in this model, as well as other animal models, can provide the basis for genetic and cellular translational human studies directed toward post-transplant obliterative bronchiolitis pathogenesis. To meet these challenges, we call for the establishment of a National Institutes of Health-supported Lung Transplant Network to better orchestrate translational research efforts in obliterative bronchiolitis pathogenesis and treatment, and to advance the field of lung transplantation.

Animals↗
PubMed1998

Acute otitis media in children with bronchiolitis.

OBJECTIVE: We investigated the prevalence and the etiology of acute otitis media (AOM) in children with bronchiolitis to determine whether AOM in such children is due entirely or mainly to respiratory syncytial virus (RSV), in which case routine antimicrobial treatment would not be appropriate. METHODS: The study group consisted of children aged 2 to 24 months with bronchiolitis. In patients with AOM at entry, nasal washings for RSV enzyme-linked immunosorbent assay were obtained, and Gram-stained smear, bacterial culture, and reverse transcriptase polymerase chain reaction to detect the presence of RSV were performed on middle-ear aspirates. Patients without AOM were reevaluated at 48 to 72 hours, 8 to 10 days, and 18 to 22 days. RESULTS: Forty-two children with bronchiolitis were enrolled. Sixty-two percent had AOM at entry or developed AOM within 10 days. An additional 24% had or eventually developed otitis media with effusion. Only 14% remained free of both AOM and otitis media with effusion throughout the 3-week observation period. All patients with AOM had 1 or more bacterial pathogens isolated from one or both middle-ear aspirates. Of 33 middle-ear aspirates, Streptococcus pneumoniae was isolated in 15, Haemophilus influenzae in 8, Moraxella catarrhalis in 8, and Staphylococcus aureus in 2. Two middle-ear aspirates yielded 2 pathogens each; 2 aspirates had no growth. RSV was identified in 17 (71%) of 24 patients with AOM. CONCLUSION: Bacterial AOM is a complication in most children with bronchiolitis. Accordingly, in patients with bronchiolitis and associated AOM, antimicrobial treatment is indicated.

Acute Disease↗
PubMed1999

Evaluation of an evidence-based guideline for bronchiolitis.

OBJECTIVE: To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio. METHODOLOGY: A multidisciplinary team generated the guideline for infants < or = 1 year old who were admitted to the hospital with a first-time episode of typical bronchiolitis. The guideline was implemented January 15, 1997, and data on all patients admitted with bronchiolitis from that date through March 27, 1997, were compared with data on similar patients admitted in the same periods in the years 1993 through 1996. Data were extracted from hospital charts and clinical and financial databases. They included LOS and use and costs of resources ancillary to bed occupancy. RESULTS: After implementation of the guideline, admissions decreased 29% and mean LOS decreased 17%. Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients. Twenty percent fewer chest radiographs were ordered. There were significant reductions in the use of all respiratory therapies, with a 30% decrease in the use of at least 1 beta-agonist inhalation therapy. In addition, 51% fewer repeated inhalations were administered. Mean costs for all resources ancillary to bed occupancy decreased 37%. Mean costs for respiratory care services decreased 77%. CONCLUSIONS: An evidence-based clinical practice guideline for managing bronchiolitis was highly successful in modifying care during its first year of implementation.guideline, bronchiolitis, evidence-based medicine, pediatrics, outcome research.

Administration, Inhalation↗
PubMed2002

Differences in admission rates of children with bronchiolitis by pediatric and general emergency departments.

OBJECTIVE: It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status. DESIGN: Retrospective cohort review of emergency department visits from April 1992 to March 1997. SETTING: Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses approximately 850 000 people. PATIENTS: All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis). MAIN OUTCOME MEASURE: Population-standardized estimates of admission rates. RESULTS: The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, population-standardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively. CONCLUSION: Children diagnosed to have bronchiolitis at the Calgary Health Region's pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region's general emergency departments.

Alberta↗
PubMed1997

Posttransplantation physiologic features of the lung and obliterative bronchiolitis.

Obliterative bronchiolitis remains the major obstacle to long-term survival after lung transplantation. Herein we provide a brief review of the key literature as well as our own experience with this condition. Obliterative bronchiolitis has occurred in up to two-thirds of all lung transplant recipients. The characteristic physiologic changes include declines in (1) forced expiratory volume in 1 second, (2) forced vital capacity, and (3) diffusing capacity of the lungs for carbon monoxide. Lung biopsy in patients with obliterative bronchiolitis reveals occlusion of bronchioles in a patchy but extensive distribution. Mucous plugging and bronchiectasis may also be seen. Furthermore, intimal thickening of pulmonary vessels together with mild arteriosclerotic changes of the muscular and elastic pulmonary arterioles may be observed. To date, the main risk factor for the development of obliterative bronchiolitis is recurrent, severe, and persistent acute lung rejection. The recommended management is prevention because the established fibrotic condition may necessitate retransplantation.

Bronchiolitis Obliterans↗
PubMed2000

The diagnostic and therapeutic approach to acute bronchiolitis in hospitalized children in Israel: a nationwide survey.

BACKGROUND: Bronchiolitis caused by respiratory syncytial virus is one of the major causes of hospitalization in young children, especially during the winter. Recent evidence has shown that pharmacological treatment, especially nebulized epinephrine, in addition to the traditional supportive treatment, can alleviate symptoms and shorten hospitalization, but this approach is not yet widespread. OBJECTIVES: To determine whether the management of bronchiolitis in Israel is moving toward a stronger emphasis on pharmacological care. METHODS: A questionnaire on the diagnosis and management of bronchiolitis was completed by 27 heads of pediatric departments throughout Israel. The questionnaire dealt with the frequency of usage of diagnostic and selected therapeutic procedures. RESULTS: Chest X-ray and arterial blood gases are commonly used as a diagnostic aid in more than 75% of the departments, and antibiotics are prescribed routinely in 24%. Corticosteroids are still in use: 48% use systemic steroids, and 19% nebulized steroids. Nebulized epinephrine is used in 22% of the departments, while nebulized beta-agonists are used frequently in two-thirds of the departments. CONCLUSIONS: Despite convincing data that beta-agonists and steroids have no positive effect on the outcome of bronchiolitis on the one hand, and that nebulized epinephrine has advantages in children on the other, we found significant use of the former two agents and sparse use of the latter. Greater awareness is needed among pediatricians, and measures should be introduced to incorporate the new recommendations, with further study of the effect of the old and new drugs on bronchiolitis.

Administration, Inhalation↗
PubMed2001

High rates of hospitalisation for bronchiolitis in Inuit children on Baffin Island.

It has been suspected that Inuit Children on Baffin Island suffer from severe, recurrent episodes of bronchiolitis, but this has never been documented previously. This study is a retrospective chart review of children less than 48 months of age hospitalised at Baffin Regional Hospital, Nunavut with a diagnosis of bronchiolitis over a one year period. This study documented that the admission rate for bronchiolitis in the first year of life was 306 per 1000 infants on Baffin Island, with an intubation rate of 12.8% in admitted children. One quarter of the infants were born prematurely, and half had their first presentation for bronchiolitis at less than 3 months of age. Ten of the 78 cases (12.8%) were identified as having a positive test for C. trachomatis by EIA, and Respiratory syncytial Virus was identified in 14 of 50 (28%) of those tested. This study documents that bronchiolitis in Inuit children on Baffin Island is a serious health concern and needs to be studied further.

Age Distribution↗
PubMed2002

[Pulmonary function in infants with respiratory syncytial virus bronchiolitis].

OBJECTIVE: To observe the dynamics of pulmonary function in infants with respiratory syncytial virus (RSV) bronchiolitis. METHODS: The to test the pulmonary function of 31 infants with RSV bronchiolitis during acute phase at admission was tested. Pulmonary fuction test was performed for the second time among 17 out of the 31 infants during the clinical recovery phase, and performed for the third time among 10 out of the 17 infants one week after discharge. In the meantime pulmonary function test was performed in 74 healthy infants as controls. RESULTS: During the acute phase of RSV bronchiolitis, the respiratory rate (RR), peak tidal expiratory flow (PTEF), peak tidal flow/tidal volume (PF/Ve), respiratory system resistance (Rrs), and functional residual capacity per kilogram (FRC/kg) were significantly increased, while the inspiratory tidal volume (Vi), inspiratory volume per kilogram (Vi/kg), expiratory tidal volume (Ve), percent of tidal volume to peak tidal expiratory flow (%V-PF), terminal flows/peak expiratory flow (25/PF), respiratory system compliance (Crs), and respiratory system compliance per kilogram (Crs/kg) were significantly decreased as compared with those in healthy infants. Ratio of mid-expiratory to mid-inspiratory flow (ME/MI) and respiratory system time constant (Trs) showed no statistically significant differences. The tidal breathing flow-volume (TBFV) loop displayed a concave expiratory curve. During the clinical recovery phase, the above abnormal indexes showed significant improvement, except for the %V-PF, 25/PF and Crs/kg which were still lower as compared with those in healthy infants, most indexes had returned to normal. The TBFV loop showed mild decelerating expiratory limb. One week after discharge all of the indexes returned to normal. CONCLUSION: In the acute phase of RSV bronchiolitis higher resistance in small airway and obstructive ventilatory disturbance can be seen. Some of the indexes remain abnormal during the clinical recovery phase. However, the abnormalities disappear in a short time. Pulmonary function test is a valuable way for surveillance of the course and prognosis of RSV bronchiolitis. %V-PF, 25/PF, and FRC/kg are sensitive indexes.

Bronchiolitis, Viral↗
PubMedDate not supplied

[Risk factors associated with bronchiolitis in children under 2 years of age].

INTRODUCTION: The objective of this study was to determine the risk factors associated to bronchiolitis in infants less than two years of age. MATERIALS AND METHODS: Prospective case-control study was performed in a hospital of second level of attention. The sample size was calculated for a level of confidence of 95%, a power of 90%, and a difference of exposure of 15% between cases and controls. For each case, there was one control matched for age and sex. The cases were obtained in the pediatric emergency room and the controls were healthy infants who came to the preventive medicine service of the same hospital. The diagnosis of bronchiolitis was established by direct observation in accordance to clinical criteria and chest X-ray. All the patients were weighed to the moment to be included in the study, and through structured interview the following variables were investigated: family history of bronchial asthma and atopy in immediate family members, prematurity, mechanical ventilation, bronchopulmonary dysplasia, present-day breast-feeding, length of time of breast feeding, early weaning, passive tobacco smoke exposure, maternal smoking, housing and living with domestic animals. The global significance of the study was probed by multiple logistic regression. RESULTS: Were studied 110 pairs with a range of age of 10 days to 23 months (average of 7.1 +/- 4.7 months), 49 pairs were female and 61 male (ratio 1:1.2) The variablés significantly associated (P < or = 0.05) to bronchiolitis were family history of bronchial asthma in immediate family members (OR: 2.9, IC 95% 1.29-6.34) and prematurity (OR: 3.0, IC 95% 1.04-8.87). The early weaning(OR: 0.44, IC 95% 0.24-0.79) and present-day breast-feeding (OR: 0.53, IC 95% 0.30-0.95) revealed a significant negative association. The other studied variables didn't show statistically significant association with bronchiolitis. CONCLUSIONS: Factors that increase the risk of bronchiolitis are a history of prematurity, and family history of bronchial asthma. Factors that have a protective effect are early weaning, and present-day breast-feeding.

Animals↗
PubMed2003

Risk factors for admission and the role of respiratory syncytial virus-specific cytotoxic T-lymphocyte responses in children with acute bronchiolitis.

BACKGROUND: Risk factors for admission of children with acute bronchiolitis have remained controversial. Technological advances in the measurements of cytotoxic T-lymphocyte (CTL) activity, enable respiratory syncytial virus (RSV)-specific CTL activity to be studied in infants with bronchiolitis for the first time. We evaluated risk factors for admission of children with acute bronchiolitis and determined the role of CTL responses in those infected with RSV. METHOD: Children between 3 and 24 months of age presenting with bronchiolitis to the paediatric outpatient department at King Edward VIII Hospital, Durban, over a 1-year period were enrolled. Management included clinical evaluation, nasopharyngeal aspiration, standard treatment and hospitalisation if indicated. Secretions were tested with monoclonal antibodies for RSV and pooled respiratory viruses; shell vial cultures were also established. Permission was requested from parents of RSV-infected subjects for blood draws for specific cytotoxic T-cell assays and CD4/CD8 cells on admission and repeat CTL on day 7. RESULTS: Viruses were identified in 55 of the 114 subjects studied (48.2%). RSV was seen in 41 cases (74.5%). Twenty-three infants (20.2%) required admission. Risk factors associated with inpatient admissions on univariate analysis included younger mean age (7.6 months v. 10.1 months), overcrowding (p < 0.01) and indoor exposure to products of combustion of cooking fuels (p = 0.05). Only the former two were significant on multivariate analysis. RSV-specific CTL responses were obtained in 21 children (51.2%). Responses were either very weak (N = 7) or negative (N = 14) on day 0 and did not alter significantly on day 7. The mean CD4/CD8 ratios in this group were 2.27:1. The highest frequency of CTL was directed against the proteins M4/5/6', with counts ranging from 100 to 400 spot forming cells (sfc)/million. CONCLUSION: Measures to address risk factors identified in this study may decrease the need for hospitalisation from bronchiolitis. The lack of RSV-specific CTL responses in peripheral blood of immunocompetent RSV-infected children suggest an alternative method of induction of immunity or compartmentalisation of immune cells.

Acute Disease↗
PubMed2005

Respiratory syncytial virus bronchiolitis.

Respiratory syncytial virus, the most common cause of bronchiolitis, is the leading cause of infant hospitalization in developed countries and accounts for substantial mortality and morbidity in developing countries. Children at increased risk of developing severe bronchiolitis are those <6 weeks of age, those born prematurely and those with an underlying cardiopulmonary disorder or immunodeficiency. Approximately 80% of cases occur in the first year of life. By two years of age, virtually all children have been infected by at least one strain of the virus. Classically, respiratory syncytial virus bronchiolitis manifests as cough, wheezing and respiratory distress. The mainstay of treatment is supportive care, consisting of adequate fluid intake, antipyretics to control fever and use of supplemental oxygen if necessary. Frequent and meticulous hand-washing is the best measure to prevent secondary spread. Treatment of respiratory syncytial virus bronchiolitis beyond supportive care should be individualized. Palivizumab has been shown to be effective in preventing severe respiratory syncytial virus bronchiolitis in high-risk children when given prophylactically. In the majority of cases, the disease is usually self-limited. The mortality rate is <1% and occurs predominantly in children at high risk for severe disease.

Adrenal Cortex Hormones↗
PubMed2006

[Non transplant-related constrictive bronchiolitis in adults].

INTRODUCTION: The term bronchiolitis refers to inflammatory disorders of the bronchioles. Constrictive bronchiolitis is the type most frequently encountered. STATE OF THE ART/PERSPECTIVES: The main clinical manifestations include the development of exertional dyspnoea and fixed airflow obstruction. Chest x-ray findings are usually unhelpful, but CT scanning may reveal a mosaic pattern on expiration. Peripheral micronodules are less frequently seen. The causes of constrictive bronchiolitis are numerous. The diagnosis may be clear from the clinical context when a causative event or predisposing condition can be identified (lung or bone marrow transplantation, toxic fume or gas inhalation, rheumatoid arthritis); in other conditions, a stepwise approach to the diagnosis is usually recommended in order to exclude other causes of subacute or chronic obstructive disease. Formal diagnosis requires histological examination of surgical lung biopsies. Despite corticosteroid administration, respiratory failure usually develops. Specific inhibitors of pro-inflammatory cytokines may offer a new and promising therapeutic approach. CONCLUSIONS: If the clinical context or the radiology and clinical findings are not highly suggestive of a constrictive bronchiolitis, a surgical lung biopsy should be considered.

Adult↗
PubMed1988

Bronchiolitis obliterans and airways obstruction associated with graft-versus-host disease.

Bronchiolitis obliterans is a nonspecific pathologic lesion seen after fume inhalation and infections, which is associated with connective tissue disorders and is a complication of organ transplantation. Bronchiolitis obliterans with organizing pneumonia is also associated with the connective tissue disorders but is usually idiopathic and has better prognosis with corticosteroid therapy. Bone marrow-related obliterative bronchiolitis is limited to patients who develop chronic graft-versus-host disease. Symptoms begin with cough in 3 to 6 months and progress to dyspnea and severe airflow obstruction. The roentgenogram is normal or shows hyperinflation. Prognosis is poor and most patients develop disabling irreversible airflow obstruction. Bronchiolitis obliterans is the most important clinical complication in heart-lung transplant recipients. It is not preceded by typical features of chronic graft-versus-host disease, but has the same clinical course of dyspnea, airflow obstruction, and poor response to therapy. Bronchiolitis obliterans in transplant recipients may represent a form of allograft rejection.

Airway Obstruction↗
PubMedDate not supplied

Management of bronchiolitis.

The incidence, etiology, epidemiology, clinical presentation, treatment, prognosis, and prevention of bronchiolitis are discussed with a critical evaluation of the available studies on various therapeutic approaches. Bronchiolitis is a lower respiratory-tract viral infection that affects 6-10% of all children below two years of age. Respiratory syncytial virus (RSV) is the usual pathogen. The symptoms range from mild wheezing to severe respiratory distress. An infected child usually has a fever, a rapid pulse, an increased breathing rate, and difficulty in breathing. Because most of the infants hospitalized with bronchiolitis have hypoxemia, the administration of oxygen is the mainstay of therapy. Correct fluid therapy is essential to avoid dehydration and overhydration. Limited data are available on the use of drugs in the management of bronchiolitis. Although a variety of adrenergic drugs, theophylline, and corticosteroids are used, sound efficacy data are lacking, and most studies have documented a lack of therapeutic benefits. One study reported that the combined use of corticosteroids and albuterol may be beneficial in severely ill patients. Recent studies have shown that the continuous administration of ribavirin may decrease viral shedding. Antibiotics are not indicated unless a secondary bacterial infection is present. Oxygen and fluid therapy have a clear role in the management of patients with bronchiolitis; however, no specific guidelines are available for the use of drugs in the treatment of these patients.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Assessment of forced expiratory volume in one second-fraction of the engrafted lung with 133-Xe radiospirometry improves the diagnosis of bronchiolitis obliterans syndrome in single lung transplant recipients.

BACKGROUND: Staging of bronchiolitis obliterans syndrome is based on the decline of forced expiratory volume in 1 second, a measure of overall ventilatory capacity. A single staging system is applied to all lung recipients, regardless of the bias which can be caused by the native lung after single lung transplantation. METHODS: We determined the decline of graft function in single lung recipients by a combination of two methods: 133-Xe radiospirometry and dynamic spirometry. The forced expiratory volume in 1 second fraction of the transplant (FEV1tx) was calculated from the proportion of ventilation of the transplant (Vtx) and forced expiratory volume in 1 second. Eight single lung recipients were followed up for a median observation period of 17 months; bronchiolitis obliterans syndrome developed in four of them. RESULTS: The fractional decline of forced expiratory volume in 1 second of the transplant was significantly greater than the decline of forced expiratory volume in 1 second (p = 0.016) in all patients during the follow-up. In the patients with bronchiolitis obliterans syndrome, the mean decline in forced expiratory volume in 1 second was 1.1 L (39.5%), and in forced expiratory volume in 1 second of the transplant it was 0.9 L (55.8%). The measurement of forced expiratory volume in 1 second of the transplant suggested stage 2a and 3a dysfunction in two grafts in which the assessment of forced expiratory volume in 1 second indicated stage 1a bronchiolitis obliterans syndrome. In one patient, decrease of forced expiratory volume in 1 second of the transplant was suggestive of chronic dysfunction 4 months before it was diagnosed by biopsy and declined lung function. CONCLUSIONS: The assessment of forced expiratory volume in 1 second seems to underestimate the severity of chronic dysfunction in single lung grafts. Instead, the determination of forced expiratory volume in 1 second of the transplant with radioactive tracers provides selective information of the graft function, which could be used for clinical evaluation of bronchiolitis obliterans syndrome in single lung recipients.

Adult↗
PubMedDate not supplied

Evaluation of transbronchial lung biopsy specimens in the diagnosis of bronchiolitis obliterans after lung transplantation.

We investigated the utility of transbronchial lung biopsy in allograft evaluation, particularly with reference to rejection-mediated bronchiolitis obliterans in 105 transplant recipients surviving 3 months or more (29 single lung, 76 double lung). A sensitivity and specificity of one transbronchial biopsy procedure with an average procurement of 7.6 tissue fragments was 17.1% and 94.5%, respectively, according to results obtained from biopsies carried out after 2 months transplantation in 29 patients with confirmed rejection-mediated bronchiolitis obliterans and 61 patients known not to have the disease. The predictive value of a positive procedure for the presence of disease was 65.5% and that of a negative procedure for the absence of disease was 65.2%. Similarly, the sensitivity and specificity for the finding of bronchiolar mural fibrosis were 18.5% and 85.3%, respectively; and, for lymphocytic bronchiolitis, the values were 1.9% and 100%, respectively. We conclude that, although the sensitivity of transbronchial biopsy and the predictive value of a procedure which shows microscopic bronchiolitis obliterans are low, attempts should be made to support a clinical diagnosis of bronchiolitis obliterans through biopsy, given the problems inherent in achieving an early and certain diagnosis according to clinical criteria alone.

Biopsy↗
PubMed1995

[Post-lung transplantation bronchiolitis obliterans].

Bronchiolitis obliterans is an anatomical lesion with multiple aetiologies. In the lung transplant patient the pure forms of bronchiolitis obliterans are probably the consequence of a process of chronic rejection; in fact necropsy tissue or lungs removed which have been transplanted show that the lesions of bronchiolitis obliterans are often associated with parenchymal disorders, vascular and proximal bronchial disease, which are sequelae of phenomena of rejection or infection. The effect of bronchiolitis obliterans on lung function is constant; this may appear progressively or in stages. Increasing immunosuppressive treatment may arrest the progress. This rarely occurs and the development of respiratory failure tends to be the rule. It is exceptional to achieve the diagnosis of bronchiolitis obliterans from the examination of a transbronchial biopsy. It is a combination of features, both clinical and respiratory function, negative bacteriology and virological investigations as well as the absence of any efficacy of conventional treatment for rejection which leads to the diagnosis. In certain cases the question of a pulmonary re-transplantation is raised.

Bronchiolitis Obliterans↗