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Occupational causes of constrictive bronchiolitis.

AbstractPURPOSE OF REVIEW:
New literature from 2009 to 2012 regarding occupational constrictive bronchiolitis challenges textbook descriptions of this disease, formerly thought to be limited to fixed airflow limitation arising in the wake of accidental overexposure to noxious chemicals. Indolent evolution of dyspnea without a recognized hazardous exposure is a more common presentation.
RECENT FINDINGS:
Biopsy-confirmed case series of constrictive bronchiolitis from US soldiers, Iranian survivors of sulfur mustard gassing, hospital-based studies, and flavoring-related cases document that indolent constrictive bronchiolitis cases can have normal spirometry or either restrictive or obstructive abnormalities. High-resolution computerized tomography studies can be normal or reflect air-trapping and mosaic attenuation on expiratory films. Thus, in the absence of noninvasive abnormalities, the diagnosis in dyspneic patients may require thoracoscopic biopsy in settings in which exposure risk has not been recognized. Many workers with occupational constrictive bronchiolitis stabilize with cessation of exposures causing bronchiolar epithelial necrosis.
SUMMARY:
Clinicians need a high index of suspicion for constrictive bronchiolitis in young patients with rapidly progressing exertional dyspnea, regardless of spirometric and radiologic findings. Identification of novel causes and exposure-response relations for known causes are needed to provide guidance for protecting workers at risk for this largely irreversible lung disease.
AuthorsKathleen Kreiss
JournalCurrent opinion in allergy and clinical immunology (Curr Opin Allergy Clin Immunol) Vol. 13 Issue 2 Pg. 167-72 (Apr 2013) ISSN: 1473-6322 [Electronic] United States
PMID23407121 (Publication Type: Journal Article, Review)
Chemical References
  • Chemical Warfare Agents
  • Mustard Gas
Topics
  • Bronchiolitis Obliterans (chemically induced, diagnosis, prevention & control)
  • Chemical Warfare Agents (toxicity)
  • Humans
  • Iran
  • Military Personnel
  • Mustard Gas (toxicity)
  • Occupational Diseases (chemically induced, diagnosis, prevention & control)
  • Occupational Exposure (adverse effects, prevention & control)
  • Tomography, X-Ray Computed
  • United States
  • Young Adult

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