Chest
SupplementDiagnosis and Management of Cough: ACCP Evidence-Based Clinical Practice GuidelinesChronic Cough Due to Nonbronchiectatic Suppurative Airway Disease (Bronchiolitis): ACCP Evidence-Based Clinical Practice Guidelines
Section snippets
DEFINITION
Abnormalities of the small airways and bronchiolar disorders are diseases that affect airways with an internal diameter of ≤ 2 mm and do not contain cartilage in their walls.1 Like other ILDs, they may be affected by variable amounts of cellular inflammation (eg, lymphocytic, neutrophilic, eosinophilic, or granulomatous), fibrosis, and architectural distortion.
If the bronchiolar abnormalities associated with asthma, COPD/emphysema, and bronchiectasis are removed, bronchiolitides can be grouped
EPIDEMIOLOGY
While few data are available on the frequency of the occurrence of these diseases, it is clear that they are not common. Generally grouped with the ILDs, they make up only a small fraction of the patients seen by a practicing pulmonologist. The prevalence of cough at presentation is unknown.
PATHOGENESIS
The pathogenesis of cough in patients with the bronchiolitides is unknown. However, the inflammation, fibrosis, and architectural distortion3 of the small airways that occur both with and without mucous hypersecretion and bronchial hyperresponsiveness is almost assuredly part, if not the entire cause.
DIAGNOSIS
As these diseases can be difficult to identify and may result from a variety of causes, and appropriate therapy often requires a specific diagnosis to be successful, a high index of suspicion and a complete evaluation are required.2 Bronchiolitis should be considered in patients with cough and incompletely or nonreversible airflow limitation associated with a clinical syndrome suggestive of infection, an underlying systemic disorder known to be associated with small airways disease, or
SPECIFIC TREATMENT
Therapy for patients with the bronchiolitis should be tailored to the specific cause or diagnosis. Infectious bronchiolitis, while uncommon in adults and usually secondary to a viral etiology (eg, respiratory syncytial virus), can result from bacterial infection (eg, Mycoplasma pneumoniae) and if identified may require prolonged antibiotic therapy with or without the addition of corticosteroids.6 In a retrospective review7 of patients who had been referred for the evaluation of chronic cough
RECOMMENDATIONS
1. In patients with cough and incomplete or irreversible airflow limitation, direct or indirect signs of small airways disease seen on HRCT scan, or purulent secretions seen on bronchoscopy, nonbronchiectatic suppurative airways disease (bronchiolitis) should be suspected as the primary cause. Level of evidence, expert opinion; benefit, substantial; grade of recommendation, E/A
2. In patients with cough in whom more common causes have been excluded, because bacterial suppurative airways disease
Definition
The lung may be affected in the patient with an IBD (ie, ulcerative colitis [UC] or Crohn disease). Direct involvement by the underlying disease, pulmonary toxicity secondary to a medication, or infection may occur. The underlying disease may involve the entire airway, from larynx to the alveolus repeating the abnormalities found in the bowel including inflammatory (lymphocytic, neutrophilic, and granulomatous), fibrotic, and destructive changes.9
Epidemiology
The prevalence of UC and Crohn disease may each
RECOMMENDATIONS
6. In the IBD patient with cough, bronchiolitis should be suspected as a potential cause. Level of evidence, low; benefit, substantial; grade of recommendation, B
7. In patients in whom IBD-related bronchiolitis is suspected, both adverse drug reaction and infection should be specifically considered. Level of evidence, expert opinion; benefit, substantial; grade of recommendation, E/A
8. In patients with IBD, therapy with both oral and inhaled corticosteroids may improve cough, and a trial of
Definition
DPB is a distinct form of small airways disease found primarily, but not solely, in Japan, Korea, and China.14 It is associated with the presence of chronic sinus disease, cough with copious purulent sputum, wheezing, and dyspnea. Obstructive physiology, suggestive radiographic features, and characteristic histopathologic findings15 on surgical lung biopsy specimens are all seen.
Epidemiology
The disease was initially described and appears to be most common in Japan, Korea, and China, and while genetics
RECOMMENDATIONS
9. In patients with chronic cough who have recently lived in Japan, Korea, or China, DPB should be considered as a potential cause. Level of evidence, low; benefit, substantial; grade of recommendation, B
10. In patients with suspected DPB, an appropriate clinical setting and characteristic HRCT scan findings may obviate the need for invasive testing and a trial of macrolide therapy (erythromycin or other 14-member ring macrolides such as clarithromycin and roxithromycin) is appropriate. Level
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Cited by (14)
Appropriateness and clinical outcome of chest computed tomography without intravenous contrast: A study conducted in Pakistan
2018, Respiratory InvestigationCitation Excerpt :Its role is well-established in the diagnosis of many pulmonary pathologies and in guiding management [5–8]. Indications for chest HRCT have been well established [6,9–12]. HRCT together with appropriate clinical history can result in a highly specific diagnosis [13].
The approach to pediatric cough
2010, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Various factors contribute to cough in bronchiolitis, including airway inflammation, fibrosis, architectural distortion of the small airways with and without mucous hypersecretion, and bronchial hyperresponsiveness.5 Bronchiolitis has various causes, including infections (such as from respiratory syncytial virus), inhalation of smoke or sulfur dioxide, collagen vascular disease, inflammatory bowel disease, immunodeficiencies, and drug reactions (such as nitrofurantoin).28 Chest radiographs may produce normal results, but clues that suggest bronchiolitis include dilation or airway wall thickening appearing as 2- to 4-mm nodular branching and linear branching with “tree-in-bud” appearance on high-resolution computed tomography.5
The Spectrum of Nonasthmatic Inflammatory Airway Diseases in Adults
2010, Otolaryngologic Clinics of North AmericaCitation Excerpt :The inflammation can involve any cell line (eosinophils, lymphocytes, macrophages, and neutrophils) and can lead to variable degrees of injury to the bronchiolar epithelium. The resulting structural distortion can be reversible or irreversible (bronchiolectasis and fibrosis).41 Bronchiolitis can be the only manifestation of various clinical syndromes or may be a part of a spectrum of histopathologic and radiographic findings that may also involve the large airways and lung parenchyma.
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