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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Bronchiolitis obliterans (‘popcorn lung’): Bronchiolitis obliterans is a progressive lung condition, which produces inflammation and scarring of the smallest airways in the lungs just before the alveoli. This can occur in many conditions (most commonly as a manifestation of graft versus host disease post lung and other transplants). This bronchiolitis produces profound air flow obstruction and is progressive and irreversible often leading to lung transplantation. An outbreak in a microwave popcorn factory was found to be due to a chemical, diacetyl, found in the sweet flavouring of the popcorn. Although banned in the EU this flavouring can still be found in some of the ‘sweet’ flavours of vaping liquid manufactured in other countries or in unregulated vaping fluid manufacture.
The Interstitial Pneumonias
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Bronchiolitis obliterans can result from complications of pneumonia and bronchiolitis due to bacteria (H. pertussis,14Legionella pneumophila15), virus (rubeola,14,16 influenza,17 adenovirus,18 respiratory syncytial virus19), mycoplasma,20 and inhalation of irritant gases (nitrogen dioxide,21,22 ozone,23 ammonia,24 and some “war gases”). In about one third of cases the cause is unknown.25 It may be associated with rheumatoid arthritis26 or with penicillamine used in its treatment.27 Penicillamine blocks cross linkage of newly synthesized collagen and elastin.28 In patients with connective tissue disorders who are more prone to bronchiolitis and bronchitis, penicillamine could modify or interfere with the healing process. Bronchiolitis obliterans may also be closely related to eosinophilic pneumonia.29
Paraneoplastic pemphigus
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Some patients who develop PNP do not demonstrate circulating autoantibodies. These patients have predominantly lichenoid skin and mucosal lesions. They commonly develop bronchiolitis obliterans. These cases have been designated as lichenoid variants of PNP. The EM-like variant portends a very poor prognosis.
Current and emerging pharmacotherapy for respiratory syncytial virus (RSV) infection in infants
Published in Expert Opinion on Pharmacotherapy, 2023
Nicola Principi, Giovanni Autore, Serafina Perrone, Susanna Esposito
ALN-RSV01 targets RSV N transcripts by forming an RNA-induced silencing complex to inhibit translation and reduce viral load [157]. As evidenced in several in vitro studies, this drug significantly impairs replication of both RSV A and B subtypes [157]. In animals, intranasal administration of ALN-RSV01 was associated with a relevant reduction of RSV lung concentrations with a greater effect when the drug was given for prophylaxis rather than for therapy [158]. In humans, studies carried out in healthy adults have shown that aerosolized ALN-RSV01 was safe and well tolerated [159] and that, when administered to experimentally infected adults, it could reduce the rate of RSV infection by 44% [160]. However, results of a phase IIb trial carried out in RSV-infected lung transplant adult patients were disappointing. Treatment of RSV infection in these patients is essential to reduce the risk that they develop new or progressive bronchiolitis obliterans syndrome (BOS) with irreversible loss of function in the transplanted lung. Unfortunately, the study missed the primary endpoint of reduced BOS in an intent-to-treat analysis of confirmed RSV infected patients (p = 0.058) [161]. This led the pharmaceutical manufacturer to suspend the further development of the drug [162].
Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army
Published in Drug and Chemical Toxicology, 2022
Marc A. Williams, Gunda Reddy, Michael J. Quinn, Amy Millikan Bell
Many of the articles available have focused specifically on the flavoring chemicals that, although regulated for ingestion, are not regulated for inhalational exposures ( Farsalinos et al.2015, Hutzler et al.2014, Behar et al. 2016, Allen et al.2016). Food product flavorings gained alarming public attention in the early 2000s because workers in microwave popcorn production facilities were reported to develop a serious lung condition referred to as bronchiolitis obliterans, following their inhalation exposure to high levels of diacetyl (2,3-butanedione), a highly volatile flavoring that was added to produce a buttery flavor (CDC 2002, Kreiss et al.2002, OSHA 2010, Halldin et al.2013). Bronchiolitis obliterans is a rare, irreversible, and debilitating disease of the lung in which acute inflammation and tissue scarring collectively obstruct the small conducting airways, i.e., the bronchioles. This condition lacks any effective treatment, and lung transplantation remains the only and most effective option (Morgan et al.2008). However, the transplant procedure itself can trigger onset of bronchiolitis obliterans due to an immunological reaction that rejects the transplanted organ, which results in subsequent poor outcomes and low overall survival rates for such transplant recipients (Kelly et al.2012).
Bronchiolitis obliterans murine model induced by nitric acid aerosol inhalation: An economical and reproducible model
Published in Experimental Lung Research, 2018
Jianing Yin, Xiaobo Ma, Fei Huang, Yucong Ma, Yanan Li
Bronchiolitis obliterans (BO) is a rare, life-threatening, and non-reversible obstructive lung disease characterized clinically by cough, wheeze, and exertional dyspnea, and pathologically by small airway narrowing and/or complete obliteration resulting from inflammatory infiltration and fibrosis of bronchiolar walls and contiguous tissues,1,2 BO could be a final outcome from severe lower respiratory infection, transplantation, toxic fume inhalation, drugs (such as penicillamine), connective tissue diseases, and even inflammatory bowel disease.3 The most common cause of BO in children is severe lower-respiratory-tract infections, particularly those infected by adenovirus,4–6 In adults, however, BO is more frequently associated with lung, heart-lung, or hematopoietic stem cell transplantation, and the leading cause of mortality from the second year following lung transplantation.2 No specific treatment is available for BO. Lung transplantation or lung volume reduction surgery can be considered for the patients who exhibit persistent and severe obstructive symptoms and progressive impairments in pulmonary function.7