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Review
. 2020 Dec;41(4):661-686.
doi: 10.1016/j.ccm.2020.08.011.

Occupational Bronchiolitis: An Update

Randall J Nett  1 , R Reid Harvey  2 , Kristin J Cummings  3
Affiliations
Review

Occupational Bronchiolitis: An Update

Randall J Nett et al. Clin Chest Med. 2020 Dec.

Abstract

Occupational bronchiolitis is characterized by inflammation of the small airways, and represents a heterogeneous set of lung conditions that can occur following a range of inhalation exposures related to work. The most common clinical presentation includes insidious onset of exertional dyspnea and cough. Multiple reports in recent years have drawn attention to previously unrecognized risk factors for occupational bronchiolitis following exposures in several settings. Both current and past occupational exposures, including prior military deployment-related exposures, should be considered in patients undergoing evaluation for unexplained dyspnea. Diagnostic testing for potential bronchiolitis should include a thorough assessment of the small airways.

Keywords: 2,3-Pentanedione; Constrictive bronchiolitis; Diacetyl; Flavoring; Military deployment; Obliterative bronchiolitis; Styrene.

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Conflict of interest statement

Disclosure The authors have nothing to disclose. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

Figures

Fig. 1.
Fig. 1.
Representative hematoxylin and eosin stains of explanted lung tissue and surgical lung biopsies from patients with lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE). These specimens highlight the primary histologic features of lymphoplasmacytic infiltrates with primary lymphoid follicles around the distal airways and notable involvement of respiratory bronchioles and alveolar ducts, in addition to diffuse emphysema. (A) Low-power view, highlighting peribronchiolar lymphoid aggregates with widespread emphysema. (B) Medium-power view, showing nonreactive lymphoid follicles with nodular extensions into the alveolar ducts (arrows); emphysema also appreciated. (C, D) High-power views of nodular lymphoid aggregates around a respiratory bronchiole and chronic inflammatory infiltrates expanding the walls of the alveolar ducts. (E) Immunochemical staining for CD20, a B-cell marker, demonstrating B cells make up most of the primary follicles. (From Cummings KJ, Stanton ML, Nett RJ, et al. Severe lung disease characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE) in industrial machine-manufacturing workers. Am J Ind Med. 2019;1–11. https://doi.org/10.1002/ajim.23038; with permission.)
See this image and copyright information in PMC

Comment in

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