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Bronchiolitis obliterans

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Abstract

Bronchiolitis obliterans (BO) is a disease of small airways that results in progressive dyspnea and airflow limitation. It is a common sequela of bone marrow, lung, and heart-lung transplantation, but can also occur as a complication of certain pulmonary infections, adverse drug reaction, toxic inhalation, and autoimmune disorders. Non-transplant-related BO is rare and can mimic asthma and chronic obstructive pulmonary disease (COPD). In transplant-related BO, the diagnosis can be suggested by obstructive changes in serial pulmonary function testings, while open lung biopsy is usually required in non-transplant cases. High-resolution computerized tomography (HRCT) is also a helpful tool to diagnose and assess the severity of BO. The treatment of BO, regarding of the cause, is usually disappointing. Systemic corticosteroid immunosuppression and retransplantation have been described with variable success.

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References

  1. Colby, T.V. (1998), Am J Clin Pathol 109(1), 101–109.

    PubMed  CAS  Google Scholar 

  2. Myers, J.L. and Colby, T.V. (1993), Clin Chest Med 14(4), 611–622.

    PubMed  CAS  Google Scholar 

  3. Schlesinger, C., Meyer, C.A., Veeraraghavan, S., and Koss, M.N. (1998), Ann Diagn Pathol 2(5), 321–334.

    Article  PubMed  CAS  Google Scholar 

  4. Boehler, A. and Estenne, M. (2000), Curr Opin Pulm Med 6(2), 133–139.

    Article  PubMed  CAS  Google Scholar 

  5. Travis, W.D., King, Jr., T.E., Bateman, B.D., et al. (2002), Am J Respir Crit Care Med 165(2), 277–304.

    Google Scholar 

  6. King, Jr., T.E. (2003), in Intestitial Lung Disease. Schwarz, M.I. and King, T.E., eds. BC Decker, London, pp. 787–824.

    Google Scholar 

  7. Markopoulo, K.D., Cool, C.D., Elliot, T.L., et al. (2002), Eur Respir J 19(1), 20–30.

    Article  PubMed  CAS  Google Scholar 

  8. Kraft, M., Mortenson, R.L., Colby, T.V., et al. (1993), Am Rev Respir Dis 148(4 Pt 1) 1093–1101.

    PubMed  CAS  Google Scholar 

  9. Steigman, D.M. and Mark, E.J. (1997), N Engl J Med 336(5), 357–364.

    Article  Google Scholar 

  10. Plopper, C.G. and Have-Opbroek, A. (1994), in Diseases of the Bronchioles. Epler, G.R., ed. Raven Press, New York, pp. 15–25.

    Google Scholar 

  11. Poletti, V., Zompatori, M., and Cancellieri, A. (1999), Sarcoidosis Vasc Diffuse Lung Dis 16(2), 183–196.

    PubMed  CAS  Google Scholar 

  12. Popper, H.H. (2000), Virchows Arch 437(5), 471–481.

    Article  PubMed  CAS  Google Scholar 

  13. Hogg, J.C., Macklem, P.T., and Thurlbeck, W.M. (1968), N Engl J Med 278(25), 1355–1360.

    Article  PubMed  CAS  Google Scholar 

  14. Muller, N.L. and Miller, R.R. (1995), Radiology 196(1), 3–12.

    PubMed  CAS  Google Scholar 

  15. Hawley, P.C. and Whitcomb, M.E. (1981), Arch Intern Med 141(10) 1324–1327.

    Article  PubMed  CAS  Google Scholar 

  16. Epler, G.R., Colby, T.V., McLoud, T.C., et al. (1985), N Engl J Med 312(3), 152–158.

    Article  PubMed  CAS  Google Scholar 

  17. Wright, J.L., Cagle, P., Churg, A., et al. (1992), Am. Rev Respir Dis 146(1), 240–262.

    PubMed  CAS  Google Scholar 

  18. Lohr, R.H., Boland, B.J., Douglas, W.W., et al. (1997), Arch Intern Med 157(12), 1323–1329.

    Article  PubMed  CAS  Google Scholar 

  19. Colby, T.V. and Myers, J.L. (1992), Semin Respir Med 13(2), 119–133.

    Google Scholar 

  20. Estenne, M., Maurer, J.R., Boehler, A., et al. (2002), J Heart Lung Transplant 21(3), 297–310.

    Article  PubMed  Google Scholar 

  21. Cooper, J.D., Billingham, M., Egan, T., et al. (1993), J Heart Lung Transplant 12(5), 713–716.

    PubMed  CAS  Google Scholar 

  22. Austin, J.H., Muller, N.L., Friedman, P.J., et al. (1996), Radiology 200(2), 327–331.

    PubMed  CAS  Google Scholar 

  23. Leslie, K.O., Colby, T.V., and Swensen, S.J. (2003), in Interstitial Lung Disease. Schwarz, M.I. and King, T.E., eds. BC Decker, London, pp. 31–53.

    Google Scholar 

  24. Sharples, L.D., McNeil, K., Stewart S., and Wallwork, J. (2002), J Heart Lung Transplant 21(2), 271–281.

    Article  PubMed  Google Scholar 

  25. Reichenspurner, H., Girgis, R.E., Robbins, R.C., et al. (1996), Ann Thorac Surg 62(5), 1467–1472; discussion 1472–1473.

    Article  PubMed  CAS  Google Scholar 

  26. Keller, C.A., Cagle, P.T., Brown, R.W., et al. (1995), Chest 107(4), 973–980.

    PubMed  CAS  Google Scholar 

  27. Milne, D.S., Gascoigne, A., Wilkes, J., et al. (1992), Transplantation 54(4), 748–750.

    Article  PubMed  CAS  Google Scholar 

  28. Milne, D.S., Gascoigne, A.D., Wilkes, J., et al. (1994), Transplantation 57(12), 1762–1766.

    PubMed  CAS  Google Scholar 

  29. Neuringer, I.P., Walsh, S.P., Mannon, R.B., et al. (2000), Transplantation 69(3), 399–405.

    Article  PubMed  CAS  Google Scholar 

  30. Boehler, A., Bai, X.H., Liu, M., et al. (1999), Am J Respir Crit Care Med 159(6), 1910–1917.

    PubMed  CAS  Google Scholar 

  31. DiGiovine, B., Lynch, J.P., 3rd, Martinez, F.J., et al. (1996), J Immunol 157(9), 4194–4202.

    PubMed  CAS  Google Scholar 

  32. Belperio, J.A., Keane, M.P., Burdick, M.D., et al. (2002), J Immunol 169(2), 1037–1049.

    PubMed  CAS  Google Scholar 

  33. Suga, M., Maclean, A.A., Keshavjee, S., et al. (2000), Am J Respir Crit Care Med 162(5), 1940–1948.

    PubMed  CAS  Google Scholar 

  34. Aris, R.M., Walsh, S., Chalermskulrat, W., et al. (2002), Am J Respir Crit Care Med 166(3), 417–422.

    Article  PubMed  Google Scholar 

  35. Myong, N.H., Shin, D.H., and Lee, K.Y. (2001), J Korean Med Sci 16(2), 150–154.

    PubMed  CAS  Google Scholar 

  36. Lai, R.S., Chiang, A.A., Wu, M.T., et al. (1996), Lancet 348(9020), 83–85.

    Article  PubMed  CAS  Google Scholar 

  37. Chang, H., Wang, J.S., Tseng, H.H., et al. (1997), Am J Surg Pathol 21(1), 35–42.

    Article  PubMed  CAS  Google Scholar 

  38. Sweatman, M.C., Markwick, J.R., Charles, P.J., et al. (1986), Dis Markers 4(1–2), 19–26.

    PubMed  CAS  Google Scholar 

  39. Geddes, D.M., Corrin, B., Brewerton, D.A., et al. (1997), Q J Med 46(184), 427–444.

    Google Scholar 

  40. Begin, R., Masse, S., Cantin, A., et al. (1982), Am J Med 72(5), 743–750.

    Article  PubMed  CAS  Google Scholar 

  41. Geddes, D.M., Webley, M., and Emerson, P.A. (1979), Ann Rheum Dis 38(3), 222–225.

    PubMed  CAS  Google Scholar 

  42. Sassoon, C.S., McAlpine, S.W., Tashkin, D.P., et al. (1984), Arthritis Rheum 27(11), 1218–1226.

    Article  PubMed  CAS  Google Scholar 

  43. Wolfe, F., Schurle, D.R., Lin, J.J., et al. (1983), J Rheumatol 10(3) 406–410.

    PubMed  CAS  Google Scholar 

  44. van de Laar, M.A., Westermann, C.J., Wagenaar, S.S., and Dinant, H.J. (1985), Arthritis Rheum 28(1), 93–97.

    Article  PubMed  Google Scholar 

  45. Fort, J.G., Scovern, H., and Abruzzo, J.L. (1988), J Rheumatol 15(5), 850–854.

    PubMed  CAS  Google Scholar 

  46. Hayakawa, H., Sato, A., Imokawa, S., et al. (1996), Am J Respir Crit Care Med 154(5), 1531–1536.

    PubMed  CAS  Google Scholar 

  47. Porter, D.R. (1992), Ann Rheum Dis 51(7), 927.

    PubMed  CAS  Google Scholar 

  48. Steen, V.D., Owens, G.R., Redmond, C., et al. (1985), Arthritis Rheum 28(8), 882–888.

    Article  PubMed  CAS  Google Scholar 

  49. Weiss, S.M. and Lakshminarayan, S. (1994), Clin Chest Med 15(1), 103–116.

    PubMed  CAS  Google Scholar 

  50. Douglas, W.W., Hepper, N.G. and Colby, T.V. (1989), Mayo Clin Proc 64(3), 291–304.

    PubMed  CAS  Google Scholar 

  51. King, Jr., T.E. (1998), in Fishman's Pulmonary Diseases and Disorders. Fishman, A.P., ed. McGraw-Hill, New York, pp. 825–847.

    Google Scholar 

  52. Schachter, E.N. (2002), N Engl J Med 347(5), 360–361.

    Article  PubMed  Google Scholar 

  53. Fleming, G.M., Chester, E.H., and Montenegro, H.D. (1979), Chest 75(6), 720–721.

    PubMed  CAS  Google Scholar 

  54. Horvath, E.P., doPico, G.A., Barbee, R.A., and Dickie, H.A. (1978), J Occup Med 20(2), 103–110.

    Article  PubMed  CAS  Google Scholar 

  55. Milne, J.E. (1969), J Occup Med 11(10), 538–547.

    PubMed  CAS  Google Scholar 

  56. Yockey, C.C., Eden, B.M., and Byrd, R.B. (1980), JAMA 244(11), 1221–1223.

    Article  PubMed  CAS  Google Scholar 

  57. Centers for Disease Control and Prevention. JAMA 287(22), 2939–2940.

  58. (2002), MMWR Morb Mortal Wkly Rep 51(16) 345–347.

  59. Kreiss, K., Gomaa, A., Kullman, G., et al. (2002), N Engl J Med 347(5), 330–338.

    Article  PubMed  Google Scholar 

  60. Hubbs, A.F., Battelli, L.A., Goldsmith, W.T., et al. (2002), Toxicol Appl Pharmacol 185(2), 128–135.

    Article  PubMed  CAS  Google Scholar 

  61. Boag, A.H., Colby, T.V., Fraire, A.E., et al. (1999), Am J Surg Pathol 23(12), 1539–1545.

    Article  PubMed  CAS  Google Scholar 

  62. Romero, S., Hernandez, L., Gil, J., et al. (1998), Eur Respir J 11(2), 265–271.

    Article  PubMed  CAS  Google Scholar 

  63. Konichezky, S., Schattner, A., Ezri T., et al. (1993), Chest 104(3), 971–973.

    PubMed  CAS  Google Scholar 

  64. Beckett, W.S. (2000), N Engl J Med 342(6), 406–413.

    Article  PubMed  CAS  Google Scholar 

  65. Nikki, P., Meretoja, O., Valtonen, V., et al. (1982), Crit Care Med 10(5), 344–346.

    Article  PubMed  CAS  Google Scholar 

  66. O'Reilly, J.F. (1980), Postgrad Med J 56(661), 787–788.

    PubMed  Google Scholar 

  67. Chan, E.D., Kalayanamit, T., Lynch, D.A., et al. (1999), Chest 115(4), 1188–1194.

    Article  PubMed  CAS  Google Scholar 

  68. Wohl, M.E. and Chernick, V. (1978), Am Rev Respir Dis 118(4), 759–781.

    PubMed  CAS  Google Scholar 

  69. Smith, C.B. and Overall, J.C., Jr. (1973), Radiol Clin North Am 11(2), 261–278.

    PubMed  CAS  Google Scholar 

  70. Tanaka, N., Matsumoto, T., Kuramitsu, T., et al. (1996), J Comput Assist Tomogr 20(4), 600–608.

    Article  PubMed  CAS  Google Scholar 

  71. Takahashi, M., Murata, K., Takazakura, R., et al. (2000), Eur J Radiol 35(1), 15–29.

    Article  PubMed  CAS  Google Scholar 

  72. Seggev, J.S., Mason, U.G., 3rd, Worthen, S., et al. (1983), Chest 83(2) 169–174.

    PubMed  CAS  Google Scholar 

  73. Prabhu, M.B., Barber, D., and Cockroft, D.W. (1991), Respir Med 85(6), 535–537.

    Article  PubMed  CAS  Google Scholar 

  74. Camp, M., Mehta, J.B., and Whitson, M. (1987), Chest 92(6), 1107–1108.

    PubMed  CAS  Google Scholar 

  75. Paz, H.L., Crilley, P., Topolsky, D.L., et al. (1993), Respiration 60(2), 109–114.

    PubMed  CAS  Google Scholar 

  76. Holland, H.K., Wingard, J.R., Beschorner, W.E., et al. (1988), Blood 72(2), 621–627.

    PubMed  CAS  Google Scholar 

  77. Wahlers, T., Haverich, A., Schafers, H.J., et al. (1993), Eur J Cardiothorac Surg 7(6), 319–323; discussion 324.

    Article  PubMed  CAS  Google Scholar 

  78. Hosenpud, J.D., Bennett, L.E., Keck, B.M., et al. (2001), J Heart Lung Transplant 20(8), 805–815.

    Article  PubMed  CAS  Google Scholar 

  79. Burke, C.M., Theodore, J., Dawkins, K.D., et al. (1984), Chest 86(6), 824–829.

    PubMed  CAS  Google Scholar 

  80. Boehler, A., Vogt, P., Speich, R., et al. (1996), Eur Respir J 9(6), 1317–1319.

    Article  PubMed  CAS  Google Scholar 

  81. Bando, K., Paradis, I.L., Similo, S., et al. (1995), J Thorac Cardiovasc Surg 110(1), 4–13; discussion 13–14.

    Article  PubMed  CAS  Google Scholar 

  82. Heng, D., Sharples, L.D., McNeil, K., et al. (1998), J Heart Lung Transplant 17(12), 1255–1263.

    PubMed  CAS  Google Scholar 

  83. Reichenspurner, H., Girgis, R.E., Robbins, R.C., et al. (1995), Ann Thorac Surg 60(6), 1845–1853.

    Article  PubMed  CAS  Google Scholar 

  84. Leung, A.N., Fisher, K., Valentine, V., et al. (1998), Chest 113(2), 365–370.

    PubMed  CAS  Google Scholar 

  85. Worthy, S.A., Park, C.S., Kim, J.S., and Muller, N.L. (1997), AJR Am J Roentgenol 169(3), 673–677.

    PubMed  CAS  Google Scholar 

  86. Novick, R.J. and Stitt, L. (1998), Semin Thorac Cardiovasc Surg 10(3), 227–236.

    PubMed  CAS  Google Scholar 

  87. Epler, G.R. (1996), Curr Opin Pulm Med 2(2), 134–140.

    Article  PubMed  CAS  Google Scholar 

  88. Epler, G.R., Snider, G.L., Gaensler, E.A., et al. (1979), JAMA 242(6), 528–532.

    Article  PubMed  CAS  Google Scholar 

  89. Holness, L., Tenenbaum, J., Cooter, N.B., and Grossman, R.F. (1983), Ann Rheum Dis 42(5), 593–596.

    Article  PubMed  CAS  Google Scholar 

  90. Lahdensuo, A., Mattila, J., and Vilppula, A. (1984), Chest 85(5), 705–708.

    PubMed  CAS  Google Scholar 

  91. Luh, S.P., Lee, Y.C., Chang, Y.L., et al. (1999), Clin Transplant 13(6), 496–503.

    Article  PubMed  CAS  Google Scholar 

  92. Lai, R.S., Wang, J.S., Wu, M.T., and Hsu, H.K. (1998), Lancet 352(9122) 117–118.

    Article  PubMed  CAS  Google Scholar 

  93. Kelly, K. and Hertz, M.I. (1997), Clin Chest Med 18(2), 319–338.

    Article  PubMed  CAS  Google Scholar 

  94. Trulock, E.P. (1997), Am J Respir Crit Care Med 155(3), 789–818.

    PubMed  CAS  Google Scholar 

  95. Nathan, S.D., Ross, D.J., Belman M.J., et al. (1995), Chest 107(4), 967–972.

    PubMed  CAS  Google Scholar 

  96. Paradis, I. (1998), Am J Med Sci 315(3), 161–178.

    Article  PubMed  CAS  Google Scholar 

  97. Chaparro, C., Maurer, J.R., Chamberlain, D., et al. (1994), J Heart Lung Transplant 13(5), 758–766.

    PubMed  CAS  Google Scholar 

  98. Patterson, G.M., Wilson, S., Whang, J.L., et al. (1996), J Heart Lung Transplant 15(2), 175–181.

    PubMed  CAS  Google Scholar 

  99. Guerry-Force, M.L., Muller, N.L., Wright, J.L., et al. (1987), Am Rev Respir Dis 135(3), 705–712.

    PubMed  CAS  Google Scholar 

  100. Kindt, G.C., Weiland, J.E., Davis, W.B., et al. (1989), Am Rev Respir Dis 140(2) 483–492.

    PubMed  CAS  Google Scholar 

  101. Edwards, C., Cayton, R., and Bryan, R. (1992), J Clin Pathol 45(11), 993–998.

    Article  PubMed  CAS  Google Scholar 

  102. Turton, C.W., Williams, G., and Green, M. (1981), Thorax 36(11), 805–810.

    Article  PubMed  CAS  Google Scholar 

  103. Waitches, G.M. and Stern, E.J. (2002), Radiol Clin North Am 40(1), 21–29.

    Article  PubMed  Google Scholar 

  104. Kuhn III, C. (1995), in Pathology of the Lung. Thurlbeck, W.M.CA, ed. Thieme, New York, pp. 1–36.

    Google Scholar 

  105. Worthy, S.A. and Muller, N.L. (1998), Radiol Clin North Am 36(1), 163–173.

    Article  PubMed  CAS  Google Scholar 

  106. Hansell, D.M., Rubens, M.B., Padley, S.P., and Wells, A.U. (1997), Radiology 203(3), 721–726.

    PubMed  CAS  Google Scholar 

  107. Sweatman, M.C., Millar, A.B., Strickland, B., and Turner-Warwick, M. (1990), Clin Radiol 41(2), 116–119.

    Article  PubMed  CAS  Google Scholar 

  108. Jensen, S.P., Lynch, D.A., Brown, K.K., et al. (2002), Clin Radiol 57(12), 1078–1085.

    Article  PubMed  CAS  Google Scholar 

  109. King, T.E., Jr. (1989), Lung 167(2), 69–93.

    PubMed  Google Scholar 

  110. Finkelstein, S.M., Snyder, M., Stibbe, C.E., et al. (1999), Chest 116(1), 120–126.

    Article  PubMed  CAS  Google Scholar 

  111. Boehler, A., Kesten, S., Weder, W., and Speich, R. (1998), Chest 114(5), 1411–1426.

    PubMed  CAS  Google Scholar 

  112. Kramer, M.R., Stoehr, C., Whang, J.L., et al. (1993), J Heart Lung Transplant 12(4), 675–681.

    PubMed  CAS  Google Scholar 

  113. Reynaud-Gaubert, M., Thomas, P., Badier, M., et al. (2000), Am J Respir Crit Care Med 161(6), 1924–1929.

    PubMed  CAS  Google Scholar 

  114. Estenne, M., Van Muylem, A., Knoop, C., and Antoine, M. (2000), Am J Respir Crit Care Med 162(3 Pt 1), 1047–1051.

    PubMed  CAS  Google Scholar 

  115. Nathan, S.D., Barnett, S.D., Wohlrab, J., and Burton, N. (2003), J Heart Lung Transplant 22(4), 427–432.

    Article  PubMed  Google Scholar 

  116. Riise, G.C., Andersson, B.A., Kjellstrom, C., et al. (1999), Eur Respir J 14(5), 1123–1130.

    Article  PubMed  CAS  Google Scholar 

  117. Reynaud-Gaubert, M., Marin, V., Thirion, X., et al. (2002), J Heart Lung Transplant 21(7), 721–730.

    Article  PubMed  Google Scholar 

  118. Gabbay, E., Walters, E.H., Orsida, B. et al. (2000), Am J Respir Crit Care Med 162(6), 2182–2187.

    PubMed  CAS  Google Scholar 

  119. Tsujino, I., Nishimura, M., Ohira K., et al. (2000), Respirology 5(3), 305–307.

    Article  PubMed  CAS  Google Scholar 

  120. Paradis, I., Yousem, S., and Griffith, B. (1993), Clin Chest Med 14(4), 751–763.

    PubMed  CAS  Google Scholar 

  121. Cairn, J., Yek, T., Banner, N.R., et al. (2003), J Heart Lung Transplant 22(1), 50–57.

    Article  PubMed  CAS  Google Scholar 

  122. Whyte, R.I., Rossi, S.J., Mulligan, M.S., et al. (1997), Ann Thorac Surg 64(4) 945–948.

    Article  PubMed  CAS  Google Scholar 

  123. Roman, A., Bravo, C., Monforte, V., et al. (2002), Transplant Proc 34(1), 146–147.

    Article  PubMed  CAS  Google Scholar 

  124. Dusmet, M., Maurer, J., Winton, T., and Kesten, S. (1996), J Heart Lung Transplant 15(9), 948–954.

    PubMed  CAS  Google Scholar 

  125. Gerhardt, S.G., McDyer, J.F., Girgis, R.E., et al. (2003), Am J Respir Crit Care Med 168(1), 121–125.

    Article  PubMed  Google Scholar 

  126. Ding, I.B., Baumgartner, R.A., Schwaiblmair, M., and Behr, J. (2003), Transplantation 75(10), 1767–1769.

    Article  PubMed  Google Scholar 

  127. O'Hagan, A.R., Stillwell, P.C., Arroliga, A., and Koo, A. (1999), Chest 115(5), 1459–1462.

    Article  PubMed  Google Scholar 

  128. Diamond, D.A., Michalski, J.M., Lynch, J.P., and Trulock, E.P., 3rd. (1998), Int J Radiat Oncol Biol Phys 41(4), 795–800.

    Article  PubMed  CAS  Google Scholar 

  129. Iacono, A.T., Keenan, R.J., Duncan, S.R., et al. (1996), Am J Respir Crit Care Med 153(4 Pt 1), 1451–1455.

    PubMed  CAS  Google Scholar 

  130. Whitford, H., Walters, E.H., Levvey, B., et al. (2002), Transplantation 73(11), 1793–1799.

    Article  PubMed  CAS  Google Scholar 

  131. Stewart, K.C. and Patterson, G.A. (2001), Am J Transplant 1(3) 204–210.

    Article  PubMed  CAS  Google Scholar 

  132. Novick, R.J., Stitt, L.W., Al-Kattan, K., et al. (1998), Ann Thorac Surg 65(1), 227–234.

    Article  PubMed  CAS  Google Scholar 

  133. Maki, D.D., Gefter, W.B., and Alavi, A. (1999) Chest 116(5), 1388–1402.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Petey Laohaburanakit.

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Laohaburanakit, P., Chan, A. & Allen, R.P. Bronchiolitis obliterans. Clinic Rev Allerg Immunol 25, 259–274 (2003). https://doi.org/10.1385/CRIAI:25:3:259

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