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Bronchiolitis

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Diffuse Lung Disease

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Abstract

Bronchiolitis is defined as an inflammatory process involving the bronchioles that may be associated with fibrosis of the bronchiolar wall. Bronchiolitis may be classified according to its etiology, onset (acute or chronic), or pathology. Cellular bronchiolitis corresponds to the infiltration of bronchiolar walls by inflammatory cells. Bronchiolitis obliterans is characterized by the narrowing of the caliber of the bronchiole as a consequence of fibrosis, with constrictive bronchiolitis obliterans consisting of concentric fibrosis in the wall of the bronchiole and narrowing of the bronchiolar lumen, and proliferative bronchiolitis obliterans (found in association with organizing pneumonia) characterized by buds of granulation tissue within the lumen of the bronchiole. Bronchiolitis that reduces the caliber of the small airways (constrictive bronchiolitis) typically results in nonreversible airflow obstruction. Characteristic features of bronchiolar disease on high-resolution tomography of the chest consist of a combination of centrilobular nodules, V- or Y-shaped branching linear opacities (tree-in-bud pattern), bronchiolar dilation, and the mosaic attenuation pattern on expiratory images. The main determined causes of bronchiolitis include infection especially due to respiratory syncytial virus (RSV), acute inhalational injury by toxic gases or fumes, drugs (penicillamine), intake of juice from Sauropus androgynus, and occupational exposures (asbestos, nonasbestos mineral dusts, inhaled diacetyl used as butter-flavoring ingredients in microwave-popcorn plants, synthetic polymers in industrial flockers). Bronchiolitis may further occur in well-characterized contexts, especially in rheumatoid arthritis, Sjögren syndrome, following lung transplantation or bone marrow graft, and rarely in paraneoplastic pemphigus. Cryptogenic constrictive bronchiolitis is a rare cause of airflow obstruction predominating in females between 40 and 60 year old. Bronchiolitis may also be observed as an associated pathological finding in a variety of conditions affecting the airways (chronic obstructive pulmonary disease, bronchiectasis, respiratory bronchiolitis) or as a component of diffuse inflammatory lung disease. Management of bronchiolitis depends on the etiological context, pathologic pattern, severity of impairment of pulmonary function, and progression of disease.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Claude Bernard Lyon I University, Reference Center for Rare Pulmonary Diseases, Lyon, France

    Vincent Cottin MD, PhD & Jean-François Cordier MD

  2. Department of Respiratory Medicine, Louis Pradel University Hospital, Lyon, France

    Vincent Cottin MD, PhD & Jean-François Cordier MD

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  1. Vincent Cottin MD, PhD
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Correspondence to Jean-François Cordier MD .

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  1. University of Cincinnati, College of Medicine, Department of Internal Medicine, Eden Ave, Cincinnati, 45267-0565, Ohio, USA

    Robert P. Baughman

  2. of Respiratory Medicine, Imperial College, Emeritus Professor, Grand Ave 14, London, N10 3BB, United Kingdom

    Roland M. du Bois

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Cottin, V., Cordier, JF. (2012). Bronchiolitis. In: Baughman, R., du Bois, R. (eds) Diffuse Lung Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9771-5_18

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