Small airways diseases, excluding asthma and COPD: an overview

Abstract

This review is the summary of a workshop on small airways disease, which took place in Porquerolles, France in November 2011. The purpose of this workshop was to review the evidence on small airways (bronchiolar) involvement under various pathophysiological circumstances, excluding asthma and chronic obstructive pulmonary disease. Histopathological patterns associated with small airways disease were reviewed, including cellular and obliterative bronchiolitis. Many pathophysiological conditions have been associated with small airways disease including airway infections, connective tissue diseases and inflammatory bowel diseases, bone marrow and lung transplantation, common variable immunodeficiency disorders, diffuse panbronchiolitis, and diseases related to environmental exposures to pollutants, allergens and drugs. Pathogenesis, clinical presentation, a computed tomography scan and pulmonary function test findings are reviewed, and therapeutic options are described with the objective of providing an integrative approach to these disorders.

Severe airflow obstruction in a patient with ulcerative colitis and toxic epidermal necrolysis: A case report

“…In the present patient, a chest CT scan showed bronchiectasis and thickening of the walls of the central bronchi in both lungs. In the present case, the patient had UC and had received plasma exchange for the treatment of TEN, which are known causes of OB (1,(4)(5)(6)23). TEN and Stevens-Johnson syndrome are defined as drug-related dermatopathies on the same spectrum (4), and a case of severe OB associated with TEN has been previously reported (24).…”

“…The narrowing of bronchioles by necrotic and fibrotic changes are the main pathogeneses of OB (1,26); however, the majority of the patients with OB have exertional dyspnea with airflow limitation and it may, therefore, be challenging to obtain sufficient specimens from these individuals. The present patient declined a surgical approach, and the lung specimen could not be obtained.…”

“…This inflammatory process is associated with numerous conditions, including UC (5-7), bullous skin disease (8), Stevens-Johnson syndrome (9)(10)(11)(12)(13)(14), graft versus host disease following a lung or bone marrow transplant (15)(16)(17)(18) and certain drugs (1,6). The current patient was a middle-aged ex-smoker who complained of sub-acutely developed exertional dyspnea.…”

“…Obstructive bronchiolitis (OB) is a rare disease and affects small airways of the lung and is associated with restriction of the airways (1). OB must be considered as a potential diagnosis in patients with obstructive respiratory impairment, the most common symptom of which is dyspnea (1).…”

“…OB must be considered as a potential diagnosis in patients with obstructive respiratory impairment, the most common symptom of which is dyspnea (1). This inflammatory process is associated with various conditions, including ulcerative colitis (UC) and toxic epidermal necrolysis (TEN).…”