High-Resolution Computed Tomography of Bronchiolitis Obliterans Syndrome after Bone Marrow Transplantation

Ooi, G. C.; Peh, Wilfred C.G.; Ip, Mary S.M.

doi:10.1159/000029257

Cited by 40 publications

(28 citation statements)

References 20 publications

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“…Bronchiectasis, bronchial wall thickening, cough and bronchorrhea in the patients from the present study with OB suggest comprehensive airways disease, involving both bronchioles and bronchi of all size. Therefore, airway disease with OB occurring in RA compares to that complicating bone marrow transplantation [21,38] and lung transplantation [21].…”

Section: Discussionmentioning

confidence: 99%

Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis

Devouassoux

Cottin²,

Lioté³

et al. 2009

Eur Respir J

108

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The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated.A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ,50% and/or residual volume (RV)/total lung capacity (TLC) .140% predicted) was conducted.Patients (mean¡SD age 64¡11 yrs) included 17 never-smokers and eight ex-smokers (10.5¡5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV1 41¡12% pred, FEV1/FVC 49¡14%, FVC 70¡20% pred, RV 148¡68% pred and RV/TLC 142¡34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2¡49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died.Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.

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Section: Discussionmentioning

confidence: 99%

Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis

Devouassoux

Cottin²,

Lioté³

et al. 2009

Eur Respir J

108

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“…12 These criteria were modified to include the following five criteria: (1) airway obstruction7hypoxaemia not normalizing after b-2 agonist treatment, [13][14][15] (2) absence of pulmonary infiltrates, (3) absence of infectious organisms in blood and respiratory secretion7bronchoal-veolar lavage, (4) reduction in FEV 1 in the absence of airway restriction (in patients cooperating in pulmonary function measurements), 14,15 (5) bronchial dilatation and mosaic pattern of attenuation on high-resolution CT scan. [16][17][18] Patients fulfilling at least four of five criteria were diagnosed as BO and treated with high-dose pulse corticosteroid therapy (methylprednisolone 10 mg/kg body weight/day) for 3 days. Courses of pulse therapy were repeated on a monthly basis in patients with continuous symptoms up to a maximum of six cycles.…”

Section: Methodsmentioning

confidence: 99%

High-dose corticosteroid therapy for bronchiolitis obliterans after bone marrow transplantation in children

Ratjen

Rjabko

Kremens

2005

Bone Marrow Transplant

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Summary:Bronchiolitis obliterans (BO) is a rare but serious complication of paediatric allogenic bone marrow transplantation (BMT). Currently, there is no clear evidence that therapeutic interventions have a positive impact on the course of the disease. We here report our experience with high-dose pulse methylprednisolone therapy in children after BMT. Nine patients fulfilling clinical and radiologic signs of BO were included in this analysis. The total amount of treatment cycles with pulse methylprednisolone therapy ranged from 1 to 6 cycles (median four cycles). Oxygen saturation increased significantly with normalization of oxygen saturation at the end of therapy in all individuals. Normal oxygen saturation was maintained in all but one patient during follow-up (mean follow-up period 42 {plus/minus} 20 months, range 19-67 months). Forced expiratory volume in 1 s (FEV1) was within the normal range prior BMT and significantly diminished at the time of BO diagnosis. Treatment led to stabilization of lung function, with a significant improvement of FEV1 after 2 months. In all, 7/9 patients remained in clinically stable condition without further deterioration of lung function during follow-up. These data would suggest that anti-inflammatory therapy may be a valuable treatment option in paediatric patients with bronchiolitis obliterans after BMT. Bone Marrow Transplantation (2005) 36, 135-138.

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“…Chest radiographs and CT scanning may reveal hyperinflation with or without infiltrates and vascular attenuation; however, radiologic findings do not correlate with lung function changes probably because of the patchy nature of the disease. 63 Bronchoscopy with transbronchial biopsy can help to rule out infection and may reveal obliteration of bronchioles with granulation tissue, mononuclear cell infiltration, or fibrosis. It is not clear to what extent combined immunosuppressive treatment can be effective in the treatment of this disease, which typically does not respond to treatment with steroids.…”

Section: Chronic Obstructive Lung Diseasementioning

confidence: 99%