1
|
Homma S, Ebina M, Kuwano K, Goto H, Sakai F, Sakamoto S, Johkoh T, Sugino K, Tachibana T, Terasaki Y, Nishioka Y, Hagiwara K, Hashimoto N, Hasegawa Y, Hebisawa A. Intractable diffuse pulmonary diseases: Manual for diagnosis and treatment. Respir Investig 2021; 59:8-33. [PMID: 32622842 DOI: 10.1016/j.resinv.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
This manual has been compiled by a joint production committee with the Diffuse Lung Disease Assembly of the Japanese Respiratory Society (JRS) to provide a practical manual for the epidemiology, diagnosis, and treatment of intractable diffuse pulmonary diseases. The contents are based upon the results of research into these diseases by the Diffuse Pulmonary Diseases Study Group (principal researcher: Sakae Homma) supported by the FY2014-FY2016 Health and Labor Sciences Research Grant on Intractable Diseases. This manual focuses on: 1) pulmonary alveolar microlithiasis, 2) bronchiolitis obliterans, and 3) Hermansky-Pudlak Syndrome with interstitial pneumonia. As these are rare/intractable diffuse lung diseases (2 and 3 were first recognized as specified intractable diseases in 2015), there have not been sufficient epidemiological studies made, and there has been little progress in formulating diagnostic criteria and severity scales; however, the results of Japan's first surveys and research into such details are presented herein. In addition, the manual provides treatment guidance and actual cases for each disease, aiming to assist in the establishment of future modalities. The manual was produced with the goal of enabling clinicians specialized in respiratory apparatus to handle these diseases in clinical settings and of further advancing future research and treatment.
Collapse
Affiliation(s)
- Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Diseases Research, School of Medicine, Toho University, Tokyo, Japan.
| | - Masahito Ebina
- Department of Respiratory Medicine in the 1st Internal Medicine, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan.
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan.
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
| | - Teruo Tachibana
- Department of Internal Medicine, Aizenbashi Hospital, Osaka, Japan.
| | - Yasahiro Terasaki
- Department of Pathology (Analytic Human Pathology), Nippon Medical School, Tokyo, Japan.
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Jichi Medical University, Saitama, Japan.
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Akira Hebisawa
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
| |
Collapse
|
2
|
Watanabe Y, Kawabata Y, Iwai Y, Kudo F, Kawamura R, Miwa C, Nagai Y, Koyama S. Early-stage diffuse panbronchiolitis in a young patient confirmed by video-assisted lung biopsy: A case report. J Gen Fam Med 2017; 18:411-413. [PMID: 29264074 PMCID: PMC5729367 DOI: 10.1002/jgf2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/12/2016] [Indexed: 11/11/2022] Open
Abstract
A 29-year-old man presented with sputum and cough, which were pointed out by his neighbors. A high-resolution chest computed tomography scan showed well-defined multiple centrilobular nodules and a tree-in-bud pattern. Chest auscultation revealed coarse crackles. He did not report any nasal sinus symptoms. We subsequently performed a video-assisted lung biopsy; the specimen confirmed diffuse panbronchiolitis. Subsequently, sinusitis was confirmed by an otolaryngologist. His symptoms gradually improved following treatment with erythromycin. We report a case of early-stage diffuse panbronchiolitis in a young patient, with multiple intralobular nodules, no bronchiectasis, and a good clinical course.
Collapse
Affiliation(s)
- Yasutaka Watanabe
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Yoshinori Kawabata
- Division of Diagnostic Pathology Saitama Prefectural Cardiovascular and Respiratory Center Kumagaya City Saitama Japan
| | - Yuki Iwai
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Fumiaki Kudo
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Rumi Kawamura
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Chihiro Miwa
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Yoshiaki Nagai
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Shinichiro Koyama
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| |
Collapse
|
3
|
Kim HY, Son SK, Park HJ. Diffuse panbronchiolitis in an adolescent female. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hyung Young Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Seung Kook Son
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Hee Ju Park
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| |
Collapse
|
4
|
Chuang MC, Chou YT, Lin YC, Hsieh MJ, Tsai YH. Diffuse panbronchiolitis-The response and recurrence after erythromycin therapy. J Formos Med Assoc 2015; 115:876-882. [PMID: 26705139 DOI: 10.1016/j.jfma.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/24/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/PURPOSE Diffuse panbronchiolitis (DPB) is a rare clinicopathological entity. To date, no cohort study of DPB has been conducted in Taiwan. Erythromycin treatment improves the clinical outcome of DPB; however, whether relapse will occur or not is unclear. Herein, we report the first retrospective cohort of DPB patients in one medical center in Taiwan, including their clinical presentation and outcomes of erythromycin treatment. METHODS The study comprised a retrospective cohort analysis of 27 patients with a confirmed diagnosis of DPB. Clinical, radiological, and laboratory parameters were analyzed, and the course and outcome of erythromycin treatment were examined. RESULTS The mean age at symptom onset was 56.6 ± 18.5 years, and the time between symptom onset and a correct diagnosis was 4.3 ± 4.2 years. The percentages of patients with centrilobular micronodules on chest computed tomography, obstructive ventilator impairment with hypoxemia, and an elevated cold agglutinin titer were 72%, 37%, and 78%, respectively. After erythromycin treatment, 22 of the 27 (81.5%) patients showed clinical improvement, of whom six suffered a relapse. Four of these six patients clinically improved after a second course of erythromycin treatment. CONCLUSION Erythromycin therapy was suitable for DPB in our experience. In this study cohort, 27% experienced a relapse, of which two-thirds of the patients improved after a second course of erythromycin treatment.
Collapse
Affiliation(s)
- Min-Chun Chuang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - Yu-Ting Chou
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Taiwan
| | - Yu-Ching Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Taiwan
| | - Ying-Huang Tsai
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Taiwan.
| |
Collapse
|
5
|
Chen W, Shao C, Song Y, Bai C. Primary ciliary dyskinesia complicated with diffuse panbronchiolitis: a case report and literature review. CLINICAL RESPIRATORY JOURNAL 2014; 8:425-30. [PMID: 24308375 PMCID: PMC4237194 DOI: 10.1111/crj.12089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 11/10/2013] [Accepted: 12/02/2013] [Indexed: 12/19/2022]
Abstract
Background Fifty percent of patients with primary ciliary dyskinesia (PCD) have situs inversus. Diffuse panbronchiolitis (DPB) might be one of the characteristic features of the lung in PCD. Methods We reported a case of PCD without situs inversus, yet complicated with DPB, and did literature review. Results A 34-year-old nonsmoking Chinese woman with 6-year primary infertility suffered from recurrent episodes of respiratory tract infections since childhood. Lung auscultation revealed end-inspiratory coarse crackles. Pulmonary function tests demonstrated mild obstructive ventilation functional impairment. Lung biopsy showed respiratory bronchiolitis. Nasal mucosa cilia showed the absence of both outer and inner dynein arms of the microtubules. Saccharin test was positive. Chest images showed bronchiectasis and bronchiolitis but no situs inversus. Paranasal sinus computed tomography (CT) showed maxillary sinusitis and ethmoid sinusitis. A culture of bronchoalveolar lavage fluid was positive for Pseudomonas aeruginosa. Her conditions improved in clinical symptoms and CT images after 2 months of treatment with azithromycin. Literature review revealed that very rare patients were diagnosed as PCD complicated with diffuse DPB, and all of them had situs inversus. Conclusions The association of DPB might be one of the characteristic features of the lung in PCD. Further studies on the concurrence of these two diseases are suggested so as to elucidate the mechanism of both. Please cite this paper as: Chen W, Shao C, Song Y and Bai C. Primary ciliary dyskinesia complicated with diffuse panbronchiolitis: a case report and literature review. Clin Respir J 2014; 8: 425–430.
Collapse
Affiliation(s)
- Wei Chen
- Shanghai Institute of Respiratory Diseases, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, China; Department of Respiratory Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | | | | | | |
Collapse
|
6
|
Epler GR. Constrictive bronchiolitis obliterans: the fibrotic airway disorder. Expert Rev Respir Med 2014; 1:139-47. [DOI: 10.1586/17476348.1.1.139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Hui D, Yan F, Chen RH. The effects of azithromycin on patients with diffuse panbronchiolitis: a retrospective study of 29 cases. J Thorac Dis 2013; 5:613-7. [PMID: 24255774 DOI: 10.3978/j.issn.2072-1439.2013.09.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/02/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Diffuse panbronchiolitis (DPB), a chronic inflammatory disease of the airway, is treated with macrolide antibiotics. The ability of azithromycin to improve DPB prognosis, as detected by high-resolution computed tomography (HRCT) scans and lung function tests, has not been studied in a large retrospective of patients. Our study aims to investigate the effects of azithromycin on patients with DPB using lung function tests and radiologic images. METHODS Twenty-nine patients with DPB were studied; their medical records were collected and analyzed retrospectively. Patients studied were hospitalized in the respiratory department of the Yixing Hospital, affiliated with Jiangsu University. Azithromycin was administered for 6-17 months. Changes in lung function and HRCT scans after treatment with azithromycin for six months were compared with pre-treatment values and images respectively. RESULTS Azithromycin therapy for six months resulted in rapid improvements in lung function, demonstrated by forced expiratory volume in one second (FEV1.0%), forced expiratory volume in one second over the forced vital capacity (FEV1.0/FVC), and forced expiratory volume with 75% vital capacity (FEF75%) values. In addition, improvements were seen in small nodular shadows, dilated peripheral bronchi, bronchial wall thickening, and tree-in-bud pattern, as detected by chest HRCT scans. CONCLUSIONS Long-term therapy with azithromycin is effective for patients with DPB.
Collapse
Affiliation(s)
- Ding Hui
- Department of Pulmonary Medicine, Affiliated Yixing People's Hospital, Jiangsu University, Yixing 214200, China
| | | | | |
Collapse
|
8
|
Popper HH. Interstitial lung diseases-can pathologists arrive at an etiology-based diagnosis? A critical update. Virchows Arch 2013; 462:1-26. [PMID: 23224047 PMCID: PMC7102182 DOI: 10.1007/s00428-012-1305-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/13/2012] [Accepted: 08/17/2012] [Indexed: 01/07/2023]
Abstract
Interstitial lung diseases (ILD) encompass a group of diseases with a wide range of etiologies and a variety of tissue reactions within the lung. In many instances, a careful evaluation of the tissue reactions will result in a specific diagnosis or at least in a narrow range of differentials, which will assist the clinician to arrive at a definite diagnosis, when combining our interpretation with the clinical presentation of the patient and high-resolution computed tomography. In this review, we will exclude granulomatous pneumonias as well as vascular diseases (primary arterial pulmonary hypertension and vasculitis); however, pulmonary hypertension as a complication of interstitial processes will be mentioned. Few entities of pneumoconiosis presenting as an interstitial process will be included, whereas those with granulomatous reactions will be excluded. Drug reactions will be touched on within interstitial pneumonias, but will not be a major focus. In contrast to the present-day preferred descriptive pattern recognition, it is the author's strong belief that pathologists should always try to dig out the etiology from a tissue specimen and not being satisfied with just a pattern description. It is the difference of sorting tissue reactions into boxes by their main pattern, without recognizing minor or minute reactions, which sometimes will guide one to the correct etiology-oriented interpretation. In the author's personal perspective, tissue reactions can even be sorted by their timeliness, and therefore, ordered by the time of appearance, providing an insight into the pathogenesis and course of a disease. Also, underlying immune mechanisms will be discussed briefly as far as they are essential to understand the disease.
Collapse
Affiliation(s)
- Helmut H Popper
- Research Unit for Molecular Lung and Pleura Pathology, Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, Graz, 8036, Austria.
| |
Collapse
|
9
|
Nakamura Y, Suda T, Kaida Y, Kono M, Hozumi H, Hashimoto D, Enomoto N, Fujisawa T, Inui N, Imokawa S, Yasuda K, Shirai T, Suganuma H, Morita S, Hayakawa H, Takehara Y, Colby TV, Chida K. Rheumatoid lung disease: prognostic analysis of 54 biopsy-proven cases. Respir Med 2012; 106:1164-9. [PMID: 22560113 DOI: 10.1016/j.rmed.2012.04.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/18/2012] [Accepted: 04/10/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the prognostic significance of histopathological characteristics in patients with biopsy-proven rheumatoid lung disease (RLD). MATERIALS AND METHODS Retrospective analysis was conducted on samples from 54 RLD patients who underwent surgical lung biopsies (SLBs) at Hamamatsu University Hospital and affiliated hospitals between 1980 and 2009. The overall survival rate, the spectrum of histopathological diagnosis and their associated prognostic significance were investigated. RESULTS The study group consisted of 30 men and 24 women with a median age of 60.3 years. Histopathological analysis revealed the following: usual interstitial pneumonia (UIP), 15 cases; nonspecific interstitial pneumonia/fibrosis, 16 cases; organizing pneumonia, 4 cases; unclassifiable, 2 cases; desquamative interstitial pneumonia, 1 case; and bronchiolar disease, 16 cases. In survival outcome, 10 yr survival rate was 76.6%. Patients with UIP had significantly worse prognosis than those with non-UIP (RLD cases except those with UIP) (p = 0.0452). CONCLUSION RLD includes several histopathological groups. Patients with UIP have worse survival than those with other types of RLD. Histopathological diagnosis may have a major impact on prognostication in patients with RLD.
Collapse
Affiliation(s)
- Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Sugino K, Hebisawa A, Uekusa T, Hatanaka K, Abe H, Homma S. Histopathological bronchial reconstruction of human bronchiolitis obliterans. Pathol Int 2011; 61:192-201. [DOI: 10.1111/j.1440-1827.2010.02637.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Diffuse panbronchiolitis in a 67-year-old Chinese man. Emerg Radiol 2010; 18:169-71. [DOI: 10.1007/s10140-010-0915-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
|
12
|
Abstract
CONTEXT The term small airways disease encompasses a generally poorly understood group of lung diseases that may arise primarily within the small airways or secondarily from diseases primarily affecting the bronchi or lung parenchyma. Their histology may be confusing; however, because treatments and prognoses vary, correct pathologic diagnosis is important. OBJECTIVE To present a nonexhaustive review of the pathology of primary and secondary small airways diseases, including small airways disease related to tobacco; to various other exposures, including mineral dusts; to diseases involving other areas of the lung with secondary bronchiolar involvement; and to recently described bronchiolitic disorders. DATA SOURCES Current literature is reviewed. CONCLUSIONS Small airways diseases include a wide variety of diseases of which the pathologist must consider. Uncommon conditions such as diffuse idiopathic neuroendocrine cell hyperplasia and diffuse panbronchiolitis may show relatively specific diagnostic features histologically; however, most small airways diseases exhibit nonspecific histologic features. Conditions not considered primary pulmonary diseases, such as collagen vascular diseases, bone marrow transplantation, and inflammatory bowel disease, must also be considered in patients with small airways changes histologically. Clinical and radiologic correlation is important for obtaining the best possible diagnosis.
Collapse
Affiliation(s)
- Timothy Craig Allen
- Department of Pathology, The University of Texas Health Science Center at Tyler, Tyler, TX 75708-3154, USA.
| |
Collapse
|
13
|
Abstract
Small airways diseases are best defined pathologically as a diverse group of conditions that primarily involve bronchioles and acartilagenous airways 2 mm or less in diameter, which include membranous bronchioles, respiratory bronchioles, and alveolar ducts. Small airways can be involved with disease primarily or secondarily. The concept of small airways disease varies among specialties, with clinicians generally considering them in terms of terminal airway changes causing airflow obstruction, radiologists considering them in the context of direct signs and indirect signs identified on high-resolution computed tomography scans, and pathologists evaluating them based entirely or almost entirely on the histologic changes present in the bronchioles, with or without associated changes involving bronchi and alveoli. The histologic features of small airways diseases may be confusing because they overlap. There may be incomplete assessment of the histologic process with limited biopsy. Other disease processes may occur along with a small airways disease, and may obscure or confound its histologic features. This article focuses on the histologic changes diagnostic of a variety of primary and secondary small airways diseases. Because the histologic features involve bronchioles, gross findings are often minimal and/or nonspecific. The article provides a nonexhaustive examination of conditions and diseases involving the small airways, focusing on the microscopic features, with emphasis on the limitations of histologic diagnosis and differential diagnosis.
Collapse
Affiliation(s)
- Timothy Craig Allen
- Department of Pathology, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Tyler, TX 75708, USA.
| |
Collapse
|