Fibrosing Bronchiolitis Evolving from Infectious or Inhalational Acute Bronchiolitis. A Reversible Lesion

Ryerson, Christopher J.; Olsen, Sharla-Rae; Carlsten, Chris; Donagh, Carol; Bilawich, Ana Maria; Field, Stephen K.; Churg, Andrew

doi:10.1513/annalsats.201504-234bc

Cited by 13 publications

(10 citation statements)

References 9 publications

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“…identified in humans. 38 Although this acute form has not yet been identified in cats, treating with immunosuppressive drugs to prevent permanent bronchiolar fibrosis has important implications. A diagnosis of feline asthma is frequently made based on thoracic radiography showing hyperinflation with a bronchial or bronchointerstitial pattern (with or without lobar atelectasis) and is the major obstructive airway disorder clinically described in cats.…”

Section: Classification Of Bronchiolar Disordersmentioning

confidence: 99%

Perspectives in veterinary medicine: Description and classification of bronchiolar disorders in cats

Reinero

Masseau

Grobman

et al. 2019

Veterinary Internal Medicne

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This Perspectives in Veterinary Medicine article seeks to define, describe putative causes, and discuss key diagnostic tests for primary and secondary bronchiolar disorders to propose a classification scheme in cats with support from a literature review and case examples. The small airways (bronchioles with inner diameters <2 mm), located at the transitional zone between larger conducting airways and the pulmonary acinus, have been overlooked as major contributors to clinical syndromes of respiratory disease in cats. Because the trigger for many bronchiolar disorders is environmental and humans live in a shared environment with similar susceptibility, understanding these diseases in pet cats has relevance to One Health. Thoracic radiography, the major imaging modality used in the diagnostic evaluation of respiratory disease in cats, has low utility in detection of bronchiolar disease. Computed tomography (CT) with paired inspiratory and expiratory scans can detect pathology centered on small airways. In humans, treatment of bronchiolar disorders is not well established because of heterogeneous presentations and often late definitive diagnosis. A review of the human and veterinary medical literature will serve as the basis for a proposed classification scheme in cats. A case series of cats with CT or histopathologic evidence of bronchiolar lesions or both, either as a primary disorder or secondary to extension from large airway disease or interstitial lung disease, will be presented. Future multi‐institutional and multidisciplinary discussions among clinicians, radiologists, and pathologists will help refine and develop this classification scheme to promote early and specific recognition and optimize treatment.

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Section: Classification Of Bronchiolar Disordersmentioning

confidence: 99%

Perspectives in veterinary medicine: Description and classification of bronchiolar disorders in cats

Reinero

Masseau

Grobman

et al. 2019

Veterinary Internal Medicne

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“…Chlorine‐exposed dogs developed inflammatory bronchiolar lesions that progressed to bronchiolitis obliterans with intraluminal fibrosis, but no treatment was tested in this study . A recent publication reported human clinical cases of inflammatory bronchiolitis obliterans lesions with incipient fibrosis of unknown causes that were effectively treated with corticosteroids . If such lesions develop in human lungs after chlorine exposure as in the animal model, then corticosteroids may be a possible treatment that could be tested to prevent the development of persistent chlorine‐induced lung disease.…”

Section: Treatment: Current Options and Future Prospectsmentioning

confidence: 99%

“…47 A recent publication reported human clinical cases of inflammatory bronchiolitis obliterans lesions with incipient fibrosis of unknown causes that were effectively treated with corticosteroids. 75 If such lesions develop in human lungs after chlorine exposure as in the animal model, then corticosteroids may be a possible treatment that could be tested to prevent the development of persistent chlorine-induced lung disease. In humans, recommended treatment for RADS/acute irritant-induced asthma once established is similar to that for asthma generally (i.e., bronchodilators and systemic corticosteroids for management of acute exacerbations and inhaled corticosteroids with bronchodilators if necessary for chronic maintenance therapy 76 ).…”

Section: Treatment: Current Options and Future Prospectsmentioning

confidence: 99%

Persistent effects of chlorine inhalation on respiratory health

Hoyle

Svendsen

2016

Annals of the New York Academy of Sciences

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Chlorine gas is a toxic respiratory irritant that is considered a chemical threat agent because of the potential for release in industrial accidents or terrorist attacks. Chlorine inhalation damages the respiratory tract, including the airways and distal lung, and can result in acute lung injury. Some individuals exposed to chlorine experience a full recovery from acute injury, whereas others develop persistent adverse effects, such as respiratory symptoms, inflammation, and lung-function decrements. In animal models, chlorine can produce persistent inflammation, remodeling, and obstruction in large or small airways, depending on species. Airways with pseudostratified epithelium are repaired efficiently, with surviving basal epithelial cells serving as progenitor cells that repopulate the complement of differentiated cell types. Distal airways lacking basal cells are repaired less efficiently, leading to chronic inflammation and fibrosis at these sites. Persistent chlorine-induced airway disease in humans is treated with asthma medication to relieve symptoms. However, such treatment does not ameliorate the underlying disease pathogenesis, so treatments that are more effective at preventing initial development of airway disease after irritant gas exposure and at reversing established disease are needed.

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“…41 The distinction is not always clear as it is poorly defined in the literature; however, the intraluminal form of fibrosing bronchiolitis shows granulation tissue plugs that variably occlude the lumen (with variable degrees of incorporation into the bronchiolar wall), with collagenization/re-epithelialization of the plugs, in a process somewhat resembling early constrictive bronchiolitis and airway confined organizing pneumonia. 42 Probably, it is associated with previous infection or inhalation, CT findings include centrilobular nodules and tree-in-bud, it is characterized by acute onset and it is potentially treatable with immunosuppressive therapy. 42…”

Section: Constrictive Bronchiolitismentioning

confidence: 99%

“…42 Probably, it is associated with previous infection or inhalation, CT findings include centrilobular nodules and tree-in-bud, it is characterized by acute onset and it is potentially treatable with immunosuppressive therapy. 42…”

Section: Constrictive Bronchiolitismentioning

confidence: 99%

Bronchiolitis and Bronchiolar Disorders

Ravaglia¹,

Poletti

2020

Semin Respir Crit Care Med

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Bronchioles are noncartilaginous small airways with internal diameter of 2 mm or less, located from approximately the eighth generation of purely air conducting airways (membranous bronchioles) down to the terminal bronchioles (the smallest airways without alveoli) and respiratory bronchioles (which communicate directly with alveolar ducts and are in the range of 0.5 mm or less in diameter). Bronchiolar injury, inflammation, and fibrosis may occur in myriad disorders including connective tissue diseases, inflammatory bowel diseases, lung transplant allograft rejection, graft versus host disease in allogeneic stem cell recipients, neuroendocrine cell hyperplasia, infections, drug toxicity (e.g., penicillamine, busulfan), inhalation injury (e.g., cigarette smoke, nylon flock, mineral dusts, hard metals, Sauropus androgynous); idiopathic, common variable immunodeficiency disorder, and a host of other disorders or insults. The spectrum of bronchiolar disorders is wide, ranging from asymptomatic to fatal obliterative bronchiolitis. In this review, we discuss the salient clinical, radiographic, and histological features of these diverse bronchiolar disorders, and discuss a management approach.

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Fibrosing Bronchiolitis Evolving from Infectious or Inhalational Acute Bronchiolitis. A Reversible Lesion

Abstract: These cases of fibrosing bronchiolitis represent an uncommon pattern of acute bronchiolitis that is reversible if detected at an early stage. Early recognition and treatment may prevent development of permanent bronchiolar fibrosis.

Cited by 13 publications

References 9 publications

Perspectives in veterinary medicine: Description and classification of bronchiolar disorders in cats

Perspectives in veterinary medicine: Description and classification of bronchiolar disorders in cats

Persistent effects of chlorine inhalation on respiratory health

Bronchiolitis and Bronchiolar Disorders

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