Constrictive Bronchiolitis Obliterans: The Fibrotic Airway Disorder

Gary R. Epler


Expert Rev Resp Med. 2007;1(1):139-147. 

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Expert Commentary

CB obliterans is an important respiratory illness because of its irreversibility. Although idiopathic CB is rare, the lesion is common among lung-transplant recipients. The lesion also occurs from certain types of toxic fumes, some connective tissue diseases, specific types of medications and post respiratory infection. Unusual exposures have recently been described as a cause of the fibrotic constrictive bronchiolar lesion, such as consumption of the leafy vegetable S. androgynus in far eastern Asia and from inhaling diacetyl, the ketone butter flavoring used in microwave popcorn production. Shortness of breath is the major symptom and the typical physiological finding is airflow obstruction that is nonresponsive to an inhaled bronchodilator agent. The chest radiograph is usually normal or may show hyperinflation. The high-resolution chest CT scan shows a mosaic pattern, air trapping by the expiratory film, bronchiolectasis and thickened small airway walls. Empirical treatment consists of a corticosteroid agent and immunosuppressive agents. Antifibrotic agents may be successful in the future. This is generally a nonsteroid-responsive lesion and, for disabling disease, lung transplantation can be a successful option.


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