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Review
. 2015 Jun;36(3):366-78.
doi: 10.1055/s-0035-1549452. Epub 2015 May 29.

Occupational and environmental bronchiolar disorders

Kristin J Cummings  1 , Kathleen Kreiss  1
Affiliations
Review

Occupational and environmental bronchiolar disorders

Kristin J Cummings et al. Semin Respir Crit Care Med. 2015 Jun.

Abstract

Occupational and environmental causes of bronchiolar disorders are recognized on the basis of case reports, case series, and, less commonly, epidemiologic investigations. Pathology may be limited to the bronchioles or also involve other components of the respiratory tract, including the alveoli. A range of clinical, functional, and radiographic findings, including symptomatic disease lacking abnormalities on noninvasive testing, poses a diagnostic challenge and highlights the value of surgical biopsy. Disease clusters in workplaces and communities have identified new etiologies, drawn attention to indolent disease that may otherwise have been categorized as idiopathic, and expanded the spectrum of histopathologic responses to an exposure. More sensitive noninvasive diagnostic tools, evidence-based therapies, and ongoing epidemiologic investigation of at-risk populations are needed to identify, treat, and prevent exposure-related bronchiolar disorders.

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Figures

Fig. 1
Fig. 1
Constrictive bronchiolitis secondary to Sauropus androgynus ingestion. (A) The lumen of this bronchiole is completely obliterated by fibrous tissue. The smooth muscle layer is intact over the upper portion of the bronchiole. (B) A portion of the lumen of this bronchiole remains (upper center), whereas the remainder has been replaced by foamy histiocytes and a few chronic inflammatory cells. The smooth muscle layer is intact over the left and lower portions of the airway. (C) Eccentric obliteration of the bronchiolar lumen is apparent, with remaining lumen to the left and the rest replaced by fibrous tissue with a few inflammatory cells. The smooth muscle layer is partially intact over the left and lower portions of the airway. (Images courtesy of Dr. Victor Roggli, Department of Pathology, Duke University School of Medicine).
Fig. 2
Fig. 2
Bronchiolitis obliterans organizing pneumonia. (A) Low power view shows young edematous connective tissue plugs within alveoli and an alveolar duct, with projection into the lumen of a respiratory bronchiole (proliferative bronchiolitis). (B) High power view shows young edematous connective tissue plug within an alveolus. Note the partial lining by epithelium (bottom) and the chronic inflammatory cells near the center of the plug. (Images courtesy of Dr. Victor Roggli, Department of Pathology, Duke University School of Medicine).
See this image and copyright information in PMC

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MeSH terms