Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

256 Bronchiolitis

General Measures

■Early recognition is important; once fibrosis occurs, it is not

reversible

■Look for etiology, comorbid conditions

■No proven role for bronchodilators, though empiric trial may provide

relief

■Corticosteroid trial for progressive disease

specific therapy

■For bronchiolitis after lung transplantation: treat for rejection

■BOOP:

➣Very steroid responsive (often improves within days)

➣Continue high dose for 2–3 mo

➣Taper slowly, as relapses may occur

➣Chronic steroids sometimes required

follow-up

■PFTs and HRCT frequently, as symptoms not helpful for monitoring

response

complications and prognosis

Complications

■Bronchiolitis can lead to bronchiolitis obliterans, bronchiolectasis,

localized emphysema

■Early diagnosis and treatment key to preventing irreversible loss of

lung function

■Can lead to oxygen dependence and respiratory failure and death

Prognosis

■Without complications, bronchiolitis usually self-limited; recovery

in days-weeks

■Bronchiolitis obliterans after bone marrow transplantation usually

does not improve with therapy

■Bronchiolitis obliterans after lung transplant may respond if treated

early; may stabilize if treated later; major cause of death in long-term

survivors

■BOOP has best prognosis: 60–70% respond to steroids, with nearly

60% demonstrating complete response