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Review
. 2023 Sep:95:104760.
doi: 10.1016/j.ebiom.2023.104760. Epub 2023 Aug 18.

Environmental and occupational bronchiolitis obliterans: new reality

Affiliations
Review

Environmental and occupational bronchiolitis obliterans: new reality

Sergey S Gutor et al. EBioMedicine. 2023 Sep.

Abstract

Patients diagnosed with environmental/occupational bronchiolitis obliterans (BO) over the last 2 decades often present with an indolent evolution of respiratory symptoms without a history of high-level, acute exposure to airborne toxins. Exertional dyspnea is the most common symptom and standard clinical and radiographic evaluation can be non-diagnostic. Lung biopsies often reveal pathological abnormalities affecting all distal lung compartments. These modern cases of BO typically exhibit the constrictive bronchiolitis phenotype of small airway remodeling, along with lymphocytic inflammation. In addition, hypertensive-type remodeling of intrapulmonary vasculature, diffuse fibroelastosis of alveolar tissue, and fibrous thickening of visceral pleura are frequently present. The diagnosis of environmental/occupational BO should be considered in patients who present with subacute onset of exertional dyspnea and a history compatible with prolonged or recurrent exposure to environmental toxins. Important areas for future studies include development of less invasive diagnostic approaches and testing of novel agents for disease prevention and treatment.

Keywords: Bronchiolitis obliterans; Constrictive bronchiolitis; Fibrosis; Inflammation; Review; Vasculopathy.

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Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

Fig. 1
Fig. 1
Histopathological phenotypes of ConB in individual bronchioles. A—normal-appearing bronchiole from non-diseased (ND) control subject. B—muscular phenotype; significant enlargement of smooth muscles (yellow arrows) in patient with sporadic ConB. C—mixed phenotype; subepithelial fibrosis and moderate enlargement of smooth muscles (yellow arrows) in U.S soldier with ConB. D—fibrosing phenotype; prominent subepithelial fibrosis without increased wall thickness in U.S soldier with ConB. Left images—hematoxylin and eosin stains; right images—Mason trichrome stains. Scale bars = 100 μm. These images were taken by Dr. Polosukhin and all authors confirm their originality.
Fig. 2
Fig. 2
Pathological abnormalities in pulmonary arteries and visceral pleura. A—bronchovascular bundles; normal-appearing intrapulmonary artery from non-diseased (ND) control subject; moderate intima thickness (red arrows) and significant media thickness (yellow arrows) in pulmonary arteries in patient with sporadic ConB. Verhoeff-Van Gieson stain. B—visceral pleura; normal-appearing visceral pleura from ND control subject; inflammation, increased vascularity (yellow arrows), fibrosis (red arrows) and thickening of visceral pleura in patient with sporadic ConB. Mason trichrome stain. C—normal-appearing alveolar tissue from ND control subject; increased collagen content within inter-alveolar septa in patient with sporadic ConB. PicroSirius red stain (inserts demonstrate collagen fluorescence). Scale bars = 100 μm. These images were taken by Dr. Polosukhin and all authors confirm their originality.

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