Occupational (?) constrictive bronchiolitis with normal physical, functional and image findings

Figueiredo, Sandra; Morais, António; Magalhães, Adriana; Moura, Conceição Souto; Almeida, João; Gomes, Isabel

doi:10.1016/s2173-5115(09)70146-0

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…In contrast to classic constrictive bronchiolitis, which can result from exposure to toxic gases or occur secondary to autoimmune disorders,22–25 constrictive bronchiolitis in soldiers was relatively mild in most cases and not accompanied by fixed airways obstruction and/or air-trapping on chest CT. In the last 2 decades, similar findings of normal spirometry and chest CT scans have been described in biopsy-confirmed case series of constrictive bronchiolitis from Iranian survivors of sulfur mustard gas exposure and studies of flavoring/popcorn factory workers 26–29. In Gulf War soldiers, it has been difficult to reconcile the degree of dyspnea and exercise intolerance with the diagnosis of constrictive bronchiolitis alone, particularly given the relatively minor PFT abnormalities.…”

Section: Discussionmentioning

confidence: 76%

“…In the last 2 decades, similar findings of normal spirometry and chest CT scans have been described in biopsy-confirmed case series of constrictive bronchiolitis from Iranian survivors of sulfur mustard gas exposure and studies of flavoring/popcorn factory workers. [26][27][28][29] In Gulf War soldiers, it has been difficult to reconcile the degree of dyspnea and exercise intolerance with the diagnosis of constrictive bronchiolitis alone, particularly given the relatively minor PFT abnormalities. However, the widespread nature of lung pathology documented in our study may offer a better explanation of the functional limitations in affected soldiers.…”

Section: Discussionmentioning

confidence: 99%

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Postdeployment Respiratory Syndrome in Soldiers With Chronic Exertional Dyspnea

Gutor

Richmond

et al. 2021

American Journal of Surgical Pathology

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After deployment to Southwest Asia, some soldiers develop persistent respiratory symptoms, including exercise intolerance and exertional dyspnea. We identified 50 soldiers with a history of deployment to Southwest Asia who presented with unexplained dyspnea and underwent an unrevealing clinical evaluation followed by surgical lung biopsy. Lung tissue specimens from 17 age-matched, nonsmoking subjects were used as controls. Quantitative histomorphometry was performed for evaluation of inflammation and pathologic remodeling of small airways, pulmonary vasculature, alveolar tissue and visceral pleura. Compared with control subjects, lung biopsies from affected soldiers revealed a variety of pathologic changes involving their distal lungs, particularly related to bronchovascular bundles. Bronchioles from soldiers had increased thickness of the lamina propria, smooth muscle hypertrophy, and increased collagen content. In adjacent arteries, smooth muscle hypertrophy and adventitial thickening resulted in increased wall-to-lumen ratio in affected soldiers. Infiltration of CD4 and CD8 T lymphocytes was noted within airway walls, along with increased formation of lymphoid follicles. In alveolar parenchyma, collagen and elastin content were increased and capillary density was reduced in interalveolar septa from soldiers compared to control subjects. In addition, pleural involvement with inflammation and/or fibrosis was present in the majority (92%) of soldiers. Clinical follow-up of 29 soldiers (ranging from 1 to 15 y) showed persistence of exertional dyspnea in all individuals and a decline in total lung capacity. Susceptible soldiers develop a postdeployment respiratory syndrome that includes exertional dyspnea and complex pathologic changes affecting small airways, pulmonary vasculature, alveolar tissue, and visceral pleura.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Postdeployment Respiratory Syndrome in Soldiers With Chronic Exertional Dyspnea

Gutor

Richmond

et al. 2021

American Journal of Surgical Pathology

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“… 12 In addition, small numbers of patients with BO have been reported in association with exposure to thionyl chloride used in battery production, 32 fly ash (a powdery material composed mostly of silica generated from the burning of finely ground coal in a broiler), 33 styrene in fiberglass-reinforced plastics workers, 34 , 35 and powder material used in copy-machines. 36 In rare cases, BO may develop without identifiable exposures and is designated as cryptogenic or sporadic BO. 37 …”

Section: Clinical Characteristics Of Modern Bomentioning

confidence: 99%

Environmental and occupational bronchiolitis obliterans: new reality

Gutor,

Miller,

Blackwell

et al. 2023

eBioMedicine

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Occupational and Environmental Bronchiolar Disorders

Cummings

Kreiss

2015

Semin Respir Crit Care Med

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Occupational and environmental causes of bronchiolar disorders are recognized on the basis of case reports, case series, and, less commonly, epidemiologic investigations. Pathology may be limited to the bronchioles or also involve other components of the respiratory tract, including the alveoli. A range of clinical, functional, and radiographic findings, including symptomatic disease lacking abnormalities on noninvasive testing, poses a diagnostic challenge and highlights the value of surgical biopsy. Disease clusters in workplaces and communities have identified new etiologies, drawn attention to indolent disease that may otherwise have been categorized as idiopathic, and expanded the spectrum of histopathologic responses to an exposure. More sensitive noninvasive diagnostic tools, evidence-based therapies, and ongoing epidemiologic investigation of at-risk populations are needed to identify, treat, and prevent exposure-related bronchiolar disorders.

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Occupational (?) constrictive bronchiolitis with normal physical, functional and image findings

Cited by 3 publications

References 5 publications

Postdeployment Respiratory Syndrome in Soldiers With Chronic Exertional Dyspnea

Postdeployment Respiratory Syndrome in Soldiers With Chronic Exertional Dyspnea

Environmental and occupational bronchiolitis obliterans: new reality

Occupational and Environmental Bronchiolar Disorders

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