Review classifying adult bronchiolitis by histopathologic pattern; diffuse aspiration bronchiolitis (DAB) is a primary bronchiolitis caused by chronic recurrent occult aspiration. Presents with insidious persistent cough, exertional dyspnea, bilateral infiltrates mimicking interstitial lung disease; CT shows centrilobular nodules and tree-in-bud opacities. Management targets underlying aspiration risk factors: GERD, sedating medications, neuromuscular disorders. Details

Retrospective Mayo Clinic series of 20 DAB patients (median age 56.5 y, M:F 2.3:1). Diagnosis by lung biopsy in 18/20. Predisposing factors for aspiration in 95% (GERD, drug abuse, dysphagia); 60% had recurrent pneumonia. Chest CT in all patients showed bilateral micronodules and tree-in-bud opacities. Interventions preventing recurrent aspiration (e.g., anti-GERD therapy) improved symptoms in the majority. Details

Reference article on diffuse aspiration bronchiolitis: risk factors include esophageal disorders (achalasia, Zenker diverticulum, esophageal carcinoma), neurologic disorders (~50%), dementia (~50%). HRCT: tree-in-bud change, poorly defined acinar opacities; consolidation not a major finding. Treatment note: chronic cough typically does not respond to beta-adrenergic bronchodilators or inhaled steroids; swallowing rehabilitation and temporary intravenous alimentation considered most effective to reduce symptoms. Details

Dieser Übersichtsartikel aus Respiratory Care (2019) bietet einen klinischen Überblick über die wichtigsten diffusen zystischen Lungenerkrankungen und betont den praktischen Einsatz des HRCT zur Differenzierung anhand von Zystenmorphologie und -verteilung. Für das Thema diffuse Aspirationsbronchiolitis trägt die Quelle vor allem die Abgrenzung follikulärer Bronchioliten und anderer klein-Atemwege-Erkrankungen im HRCT bei. Details

Cryptogenic organizing pneumonia (COP), formerly called bronchiolitis obliterans organizing pneumonia (BOOP), was first described in the 1980s and is classified as a rare idiopathic interstitial pneumonia (IIP). COP classically presents in a subacute fashion following a flu-like illness with fever, non-productive cough, and fatigue. Imaging often reveals diffuse, bilateral, peribronchovascular and peripheral, consolidative and ground-glass opacities although various imaging subtypes also exist. Physical examination may be normal or reveal inspiratory crackles. Hypoxemia, when present, is commonly identified with exertion but can also occur at rest. Diagnostic evaluation relies on excluding secondary causes of organizing pneumonia and includes a thorough history including medications, exposures, and signs or symptoms of underlying rheumatologic disease. Invasive diagnostic testing including tissue sampling allows for histopathologic confirmation of COP while excluding secondary causes including infection and malignancy. Although video-assisted thoracoscopic surgery (VATS) lung biopsy is often the preferred method of obtaining sufficient tissue, less invasive means may be employed based on patient-specific factors. A defining feature of COP is steroid-responsiveness, and most experts recommend prolonged corticosteroid courses (6-12 months). Response to corticosteroids and prognosis are typically excellent. Relapse rates range from 25 to 50% and occur most often during steroid taper or complete withdrawal necessitating additional therapy. Steroid-sparing immunosuppression may be used in select circumstances. Further study is needed to define optimal corticosteroid dose and duration. Details

Review classifying adult bronchiolitis by histopathologic pattern; diffuse aspiration bronchiolitis (DAB) is a primary bronchiolitis caused by chronic recurrent occult aspiration. Presents with insidious persistent cough, exertional dyspnea, bilateral infiltrates mimicking interstitial lung disease; CT shows centrilobular nodules and tree-in-bud opacities. Management targets underlying aspiration risk factors: GERD, sedating medications, neuromuscular disorders. Details

Retrospective Mayo Clinic series of 20 DAB patients (median age 56.5 y, M:F 2.3:1). Diagnosis by lung biopsy in 18/20. Predisposing factors for aspiration in 95% (GERD, drug abuse, dysphagia); 60% had recurrent pneumonia. Chest CT in all patients showed bilateral micronodules and tree-in-bud opacities. Interventions preventing recurrent aspiration (e.g., anti-GERD therapy) improved symptoms in the majority. Details

Reference article on diffuse aspiration bronchiolitis: risk factors include esophageal disorders (achalasia, Zenker diverticulum, esophageal carcinoma), neurologic disorders (~50%), dementia (~50%). HRCT: tree-in-bud change, poorly defined acinar opacities; consolidation not a major finding. Treatment note: chronic cough typically does not respond to beta-adrenergic bronchodilators or inhaled steroids; swallowing rehabilitation and temporary intravenous alimentation considered most effective to reduce symptoms. Details

Dieser Übersichtsartikel aus Respiratory Care (2019) bietet einen klinischen Überblick über die wichtigsten diffusen zystischen Lungenerkrankungen und betont den praktischen Einsatz des HRCT zur Differenzierung anhand von Zystenmorphologie und -verteilung. Für das Thema diffuse Aspirationsbronchiolitis trägt die Quelle vor allem die Abgrenzung follikulärer Bronchioliten und anderer klein-Atemwege-Erkrankungen im HRCT bei. Details

Cryptogenic organizing pneumonia (COP), formerly called bronchiolitis obliterans organizing pneumonia (BOOP), was first described in the 1980s and is classified as a rare idiopathic interstitial pneumonia (IIP). COP classically presents in a subacute fashion following a flu-like illness with fever, non-productive cough, and fatigue. Imaging often reveals diffuse, bilateral, peribronchovascular and peripheral, consolidative and ground-glass opacities although various imaging subtypes also exist. Physical examination may be normal or reveal inspiratory crackles. Hypoxemia, when present, is commonly identified with exertion but can also occur at rest. Diagnostic evaluation relies on excluding secondary causes of organizing pneumonia and includes a thorough history including medications, exposures, and signs or symptoms of underlying rheumatologic disease. Invasive diagnostic testing including tissue sampling allows for histopathologic confirmation of COP while excluding secondary causes including infection and malignancy. Although video-assisted thoracoscopic surgery (VATS) lung biopsy is often the preferred method of obtaining sufficient tissue, less invasive means may be employed based on patient-specific factors. A defining feature of COP is steroid-responsiveness, and most experts recommend prolonged corticosteroid courses (6-12 months). Response to corticosteroids and prognosis are typically excellent. Relapse rates range from 25 to 50% and occur most often during steroid taper or complete withdrawal necessitating additional therapy. Steroid-sparing immunosuppression may be used in select circumstances. Further study is needed to define optimal corticosteroid dose and duration. Details