Constrictive Bronchiolitis Obliterans and Veterans
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Published: 2011-06-10 - Updated: 2023-01-31
Author: Thomas C. Weiss | Contact: Disabled World (Disabled-World.com)
Peer-Reviewed Publication: N/A
Library of Related Papers: Respiratory Disorders Publications
Synopsis: Constructive bronchiolitis obliterans is a form of respiratory illness involving persons small airways that is important due to its fibrotic and irreversible nature. Soldiers are coming home from the war in Afghanistan with constrictive bronchiolitis. The disease can only be diagnosed through a biopsy. Soldiers have been exposed to 'burn pits' in Afghanistan and during the war in Iraq. The prognosis for people who experience constrictive bronchiolitis obliterans is often poor. The person's outcome is dependent upon the severity of the process and whether there is a progressive nature to their lesion.
The terminology used to describe bronchiolar diseases vary throughout nations around the world. A pathologist uses the term, constrictive bronchiolitis' and reports the lesion whether there is an airway obliteration or not. The clinical significance of the disease is usually associated with the obliteration of the person's bronchiolar airways.
The U.S. Social Security Administration (SSA) has included Obliterative Bronchiolitis as a Compassionate Allowance to expedite a disability claim.
Differentiating between forms of lesions is important because their treatment and outcomes are notably different.
A constrictive fibrotic lesion usually develops externally in a person's airway lumen, constricting their airway in a concentric way that eventually obliterates their lumen.
Inflammatory, proliferative lesion, on the other hand, develops internally from a person's airway wall, filling their lumen with an inflammatory, proliferative lesion of loose connective tissue or 'buds' of granulation.
Concentric bronchiolitis obliterans commonly involves a person's mid-bronchiolar region, with proliferative lesions often involving the person's distal bronchioles, often extending into their alveolar spaces. Such a lesion is called 'bronchiolar obliterans organizing pneumonia' or 'BOOP.'
Should the proliferative lesion a person experiences involve their mid-bronchiolar airways without alveolar involvement, their physiologic and radiographic results might be indistinguishable from a constrictive lesion. The person's response to treatment, however, is very different. A fibrotic concentric lesion does not respond to corticosteroid therapy; an intraluminal inflammatory lesion does, commonly resulting in a cure.
If the person experiences a proliferative lesion involving both their distal bronchiole airways and their alveoli, it is considered to be BOOP. There are many clinical and treatment differences between this lesion and constrictive bronchiolitis obliterans. Constrictive bronchiolitis obliterans is a form of irreversible airflow obstruction disease involving early symptoms such as 'squeaks' or 'crackles' when a person breathes in. The person presents with normal findings on their chest x-ray and has air-trapping on their expiratory high-resolution chest CT.
BOOP is a form of interstitial disease. People who experience it have symptoms such as crackles at the end of their inhalation. A chest x-ray reveals bilateral patchy infiltrates, an abnormal diffusing capacity, and high-resolution CT results showing ground-glass opacities and air bronchograms. Constrictive bronchiolitis obliterans does not respond to corticosteroid therapy, and people with it have a poor prognosis. People who experience BOOP respond well to steroid therapy and have a good prognosis. A pathologist and a clinician must distinguish between these two lesions in a person affected. There are several causes of constrictive bronchiolitis obliterans and various related conditions. Among the related conditions are:
- Idiopathic Constrictive Bronchiolitis Obliterans
- Post-infection Constrictive Bronchiolitis Obliterans
- Connective Tissue Constrictive Bronchiolitis Obliterans
- Post-Drug-Related Constrictive Bronchiolitis Obliterans
- Lung Transplantation Constrictive Bronchiolitis Obliterans
- Stem Cell Transplantation Constrictive Bronchiolitis Obliterans
- Paraneoplastic Pemphigus Constrictive Bronchiolitis Obliterans
- Stevens-Johnson Syndrome Constrictive Bronchiolitis Obliterans
- Bone Marrow Transplantation Constrictive Bronchiolitis Obliterans
- Neuroendocrine Cell Hyperplasia Constrictive Bronchiolitis Obliterans
- Inflammatory Bowel Disease Tissue Constrictive Bronchiolitis Obliterans
The idiopathic form is sporadic, while post-bone marrow transplant constrictive bronchiolitis occurs in approximately ten percent of people who have had such a transplant. Post-lung transplant lesions might occur in nearly sixty percent of people. Drug-related and post-respiratory infection-related constrictive bronchiolitis obliterans is rare. Bronchiolitis obliterans caused by the inhalation of fumes and oral toxins continues to be reported.
Soldiers are coming home from the war in Afghanistan with constrictive bronchiolitis. The disease can only be diagnosed through a biopsy. Soldiers have been exposed to 'burn pits' in Afghanistan and during the war in Iraq. Some of these burn pits are as large as football fields and contain things such as sulfur in them.
Toxic Fume Inhalation and Oral Toxin Exposure Constrictive Bronchiolitis
Specific toxic fumes can cause the concentric bronchiolitis obliterans lesion or the proliferative intraluminal bronchiolitis obliterans lesion. The traditional concentric bronchiolitis obliterans lesion from toxic fumes happens in three phases:
- In the first phase, the person does not experience any symptoms for a few hours.
- In the second phase, the person experiences Acute Respiratory Distress Syndrome or ARDS.
- During phase three, the person experiences another period without apparent symptoms for several days, then experiences constrictive bronchiolitis obliterans with irreversible airflow obstruction. The disorder has happened in people after exposure to acid-based toxic fumes, such as sulfur dioxide.
The prognosis for people who experience constrictive bronchiolitis obliterans is often poor. The person's outcome depends on the severity of the process and whether there is a progressive nature to their lesion. Therapy with corticosteroids does not affect the end-stage fibrotic process. Acute exacerbations associated with an inflammatory response might be responsive to a course of corticosteroid therapy. The major complication of this disease is chronic respiratory failure.
Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida.
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